Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory?

Madgar, Ory; Livneh, Nir; Dobriyan, Alex; Dagan, Elad; Alon, Eran E.

doi:10.1016/j.bjorl.2021.07.007

Cited by 9 publications

(12 citation statements)

References 14 publications

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“…Preemptive tracheostomy placement has been shown to be an independent risk factor for postoperative complications in patients with extensive oral cavity resections including increased rates of dysphagia, pneumonias, and LOS when compared to delayed extubation 182,190 . Between the preemptive and delayed tracheostomy groups in oral cavity resections, there remained a decrease in pneumonia rates in the delayed group 191 …”

Section: Resultsmentioning

confidence: 99%

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Enhanced recovery after surgery, current, and future considerations in head and neck cancer

List,

Knackstedt,

Liu

et al. 2023

Laryngoscope Investig Oto

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ObjectivesReview of the current and relevant literature to develop a list of evidence‐based recommendations that can be implemented in head and neck surgical practices. To provide rationale for the multiple aspects of comprehensive care for head and neck surgical patients. To improve postsurgical outcomes for head and neck surgical patients.MethodsExtensive review of the medical literature was performed and relevant studies in both the head and neck surgery and other surgical specialties were considered for inclusion.ResultsA total of 18 aspects of perioperative care were included in this review. The literature search included 276 publications considered to be the most relevant and up to date evidence. Each topic is concluded with recommendation grade and quality of evidence for the recommendation.ConclusionSince it's conception, enhanced recovery after surgery (ERAS) protocols have continued to push for comprehensive and evidence based postsurgical care to improve patient outcomes. Head and neck oncology is one of the newest fields to develop a protocol. Due to the complexity of this patient population and their postsurgical needs, a multidisciplinary approach is needed to facilitate recovery while minimizing complications. Current and future advances in head and neck cancer research will serve to strengthen and add new principles to a comprehensive ERAS protocol.Level of Evidence2a.

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Section: Resultsmentioning

confidence: 99%

“… 182 , 190 Between the preemptive and delayed tracheostomy groups in oral cavity resections, there remained a decrease in pneumonia rates in the delayed group. 191 …”

Section: Resultsmentioning

confidence: 99%

Enhanced recovery after surgery, current, and future considerations in head and neck cancer

List,

Knackstedt,

Liu

et al. 2023

Laryngoscope Investig Oto

View full text Add to dashboard Cite

show abstract

“…Surgical resection may or may not involve immediate reconstruction 4 . Airway and ventilatory management following reconstruction are critical due to potential compromises from a bulky flap, flap or airway oedema, and hematoma formation 5 . Procedures like bilateral neck dissections or resections of the mandible, tongue, and floor of the mouth pose the greatest risk of airway compromise.…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, prophylactic tracheostomy was utilized post-surgery; however, high complication rates, ranging from 4% to 45%, have prompted reconsideration of this practice 4 , 5 , 9 . Enhanced recovery after surgery programs advocate selective tracheostomy use, and newer trends support delayed extubation in the intensive care unit (ICU) to mitigate airway oedema and prevent complications 10 .…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer: a prospective observational study

Mukherjee,

Jain,

et al. 2024

JKAOMS

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“…Two airway strategies to maintain definitive perioperative airway patency in major head and neck cancer surgery exist: elective tracheostomy and delayed extubation. [1][2][3][4] The optimal perioperative management of the airway in major head and neck surgery remains an area of considerable debate. While elective tracheostomy provides a definitive airway in the postoperative period it is not without complications such as bleeding, accidental decannulation, and increased risk of pulmonary infections.…”

Section: Introductionmentioning

confidence: 99%

Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations

Cleere,

Read,

Prunty

et al. 2024

Head & Neck

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Major head and neck surgery poses a threat to perioperative airway patency. Adverse airway events are associated with significant morbidity, potentially leading to hypoxic brain injury and even death. Following a review of the literature, recommendations regarding airway management in head and neck surgery were developed with multicenter, multidisciplinary agreement among all Irish head and neck units. Immediate extubation is appropriate in many cases where there is a low risk of adverse airway events. Where a prolonged definitive airway is required, elective tracheostomy provides increased airway security postoperatively while delayed extubation may be appropriate in select cases to reduce postoperative morbidity. Local institutional protocols should be developed to care for a tracheostomy once inserted. We provide guidance on decision making surrounding airway management at time of head and neck surgery. All decisions should be agreed between the operating, anesthetic, and critical care teams.

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Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory?

Cited by 9 publications

References 14 publications

Enhanced recovery after surgery, current, and future considerations in head and neck cancer

Enhanced recovery after surgery, current, and future considerations in head and neck cancer

Clinical outcome of perioperative airway and ventilatory management in patients undergoing surgery for oral cavity cancer: a prospective observational study

Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations

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