Special Considerations in Anesthesia for Laryngeal Cancer Surgery .. Supraglottic laryngectomy offers the advantage of cure with preservation of speech for. Therefore tracheotomy was standard part of laryngectomy (usually under local anesthesia) to establish airway with general anesthesia. The anaesthetic considerations for head and neck cancer surgery are . this is physically impossible (e.g. the post-laryngectomy patient) or because oral.
|Published (Last):||16 March 2016|
|PDF File Size:||18.32 Mb|
|ePub File Size:||20.98 Mb|
|Price:||Free* [*Free Regsitration Required]|
National Center for Biotechnology InformationU. High dependency and anaesthesoa care Many head and neck surgery patients will be looked after in enhanced care by virtue of their comorbidity, the length of surgical procedure or the need to closely monitor the free flap.
Anaesthesia for total laryngectomy.
Managing the emergency stridulous patient. Management of surgical complications Neck haematoma, flap failures, fistulas and airway management issues e. Specific operative considerations The compromised airway In the patient who presents with acute airway compromise the obvious wnaesthesia is to consider a tracheostomy under local anaesthesia.
World Alliance for Patient Safety. Monitoring requirements The basic requirements for monitoring maintenance of anaesthesia and recovery are outlined in the Association of Anaesthetists of Great Britain and Ireland recommendations 4th edition, and advanced monitoring is usually only considered for long procedures or when excessive blood loss is a reasonable possibility.
Induction of anaesthesia If a patient is already at risk of airway obstruction due to tumour bulk, then it is probable that they will be at greater risk following induction of anaesthesia, whether intravenous or inhalational. Everyone involved needs to be acutely aware of what is needed by way of immediate measures e. Rigidity and distortion of the oropharyngeal tissues can interfere with facemask ventilation and conventional laryngoscopy.
Intensive Care Society, This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer. Airway considerations While patients presenting for head and neck surgery may have co-existent problems that could make airway management difficult e.
Sign In or Create an Account.
Maintenance of oxygenation is fundamental to airway management and techniques that extend the apnoeic window allow more controlled, less hurried and more careful, gentle instrumentation. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Dealing with any of these issues commonly requires senior and experienced staff and they will frequently resort to conventional oral intubation to secure the airway prior to re-establishing the compromised tracheostomy, but oral intubation may not be feasible either because this is physically impossible e.
Anaemia, malnutrition, and alcohol dependency are modifiable preoperative risk factors.
Immediately after the procedure, the anaesthetist needs laryngetomy confirm that the airway will be unobstructed e. Neck haematoma, flap failures, fistulas and airway management issues e. This sort of haemorrhage can arise suddenly and with little warning.
Fluid management and blood loss Many resections and free tissue transfers will not be associated with significant bleeding, though this is not necessarily true for tongue and mandibular resections where brisk bleeding may occur. Cardiac output monitoring to guide fluid replacement in head and neck microvascular free flap surgery — what is current practice in the UK? Length of operative procedure For lengthy operative procedures increased attention needs to be paid to the inevitable consequences of prolonged immobility, impaired homeostasis associated with general anaesthesia and the saturation of fatty tissue with anaesthetic laryngetcomy.
These situations can be very serious both because of the technical challenges posed and the limited time available for re-establishing the compromised airway. In the post-operative phase, early enteral feeding is advocated.
Many head and neck surgery patients will be looked after in enhanced care by virtue of their comorbidity, the length of surgical procedure or the need to closely monitor the free flap.
Anaesthesia for total laryngectomy.
Current practice has also been influenced by the introduction of many new intubation devices, very few of which have been reported in large series of head and neck cancer patients. The use of muscle relaxant drugs to facilitate laryngoscopy in these laryngecto,y is controversial because even if intubation conditions are improved this may be at the cost of greater risk of airway obstruction.
A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer.
The anaesthetist will usually have information about the lesion e. This is the official guideline anaeesthesia by the specialty associations involved in the care of head and neck cancer patients in the UK.
Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines
These programmes have been shown to improve outcomes in patients undergoing major colorectal and gynaecological procedures, by reducing length of stay and day morbidity. There are differences as to which patients warrant this level of airway protection and even as to suitability for delivery of such care by immediate return to the ward vs high dependency or intensive care. Prophylaxis for anaesrhesia is discussed elsewhere in these guidelines 1. Enhanced recovery in colorectal resections: In some institutions, ventilation is established prior to induction of general anaesthesia via temporary ladyngectomy or trans-tracheal access.
The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. Many resections and free tissue transfers will not be associated with significant bleeding, though this is not necessarily true for tongue and mandibular resections where brisk bleeding may occur.
Neck haematomas can be particularly deceptive because any associated airway oedema bears little resemblance to the apparent severity of neck swelling.
Cardiac monitoring was used regularly in only 9 per cent of UK units in an audit in The Journal of Laryngology and Otology. Such issues should be anticipated and discussed with the patient and relatives as part of the consent for surgery.
Management of elective laryngectomy | BJA Education | Oxford Academic
Formal tumour assessment for treatment planning examination under anesthesia and biopsy This is the more usual situation where the risk of airway obstruction is considered less likely. It is unusual for any patient to be ventilated post-operatively. Oxygenation Maintenance of oxygenation is fundamental to airway management and techniques that extend the apnoeic window allow more controlled, less hurried and more careful, gentle instrumentation.
Close mobile search navigation Article navigation. Patel Laryjgectomy, Nouraei SA. Laser surgery The risk of airway fires due to laser is low provided careful precautions including laser safe tubes are used.
J Laryngol Otol ; Suppl S2: Author information Copyright and License information Disclaimer.