Outcomes of Intubation in Difficult Airways Due to Head and Neck Pathology

Abstract

The purpose of this study was to examine the impact of surgical pathology, anesthesiologist experience, and airway technique on surgically relevant outcomes in patients identified by preoperative laryngoscopy to have a difficult airway due to head and neck pathology. We prospectively recorded a series of 152 difficult airway cases due to head and neck pathology out of 2,145 direct laryngoscopies undertaken between November 2005 and June 2008. One of two senior anesthesiologists specializing in head and neck procedures intubated 101 (66.4%) of the 152 patients and did so 3.3 minutes faster (p = 0.51), with better oxygenation (87.3 vs. 81.8%; p = 0.02) and fewer airway plan changes (p = 0.001) than did other, nonspecialist anesthesiologists. Predictors of failure of the first intubation plan included: cancer diagnosis (p = 0.02), previous radiotherapy (p = 0.03), and supraglottic lesions (p = 0.03). Glottic/subglottic lesions required the most intubation attempts (p = 0.02). Awake fiberoptic intubation was the most common method used (44.7%) but resulted in a change in the airway plan in 6 cases (8.8%). Gas induction maintained the best oxygenation (p = 0.01). Awake tracheostomy was infrequent (1.3%) and took the longest (p = 0.006). We concluded that difficult airways due to head and neck pathology require teamwork and a backup plan. An anesthesiologist specializing in head and neck procedures may help to avoid adverse outcomes associated with cancer, especially previously irradiated supraglottic/glottic lesions, leading to a less frequent need for awake tracheostomy. * >3 intubation attempts or >10 minutes of attempting intubation with no change in plan. † Change in technique from initially planned technique.

Elective tracheostomy scoring system for severe oral disease patients

“…For the oral cancer patients scoring system, a history of preoperative radiation therapy and previous surgery on the same area were intended to be included as contributing factors because patients with these histories tend to have altered anatomic landmarks and airway management can be difficult32. However, a number of patients in our hospital who met these criteria were not included in the study for statistical analysis because other factors were too limiting.…”

Breves consideraciones sobre el síndrome de dolor-disfunción de la ATM en el paciente con deformidad dentofacial

“…Se realiza con el paciente despierto y en respiración espontánea. El anestesista debe estar entrenado para emplear esta técnica con soltura 3 .…”

Airway Management During Anesthetic Induction of Secondary Laryngectomy for Recurrent Laryngeal Cancer: Three Cases of Report and Analysis

“…Securing airway is essential for the management of anesthesia in head and neck surgery, and reinforced evaluation of the airway must be performed preoperatively. For recurrent laryngeal cancer surgery, special considerations are necessary, and a safe airway management strategy should be planned in cases of stenosis, metastasis, contracture of the previous incision scar and dermal tension in the cervical area resulting from radiation therapy ( 8 – 11 ). In our three reported cases, only one of them was intubated successfully, while the other two patients had a very difficult airway anatomy that even limited the fibroscopy.…”