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):||12 January 2014|
|PDF File Size:||7.51 Mb|
|ePub File Size:||16.41 Mb|
|Price:||Free* [*Free Regsitration Required]|
Tubeless anaesthesia Ideally, any surgeon would wish to have an unrestricted view of the lesion to be operated on. Neck haematoma, flap failures, fistulas and airway management issues e. The use of muscle relaxant drugs to facilitate laryngoscopy in these cases is controversial because even if intubation conditions are improved this may be at the cost of greater risk laryngectomg airway obstruction.
Enhanced recovery programmes ERP for head and neck cancer patients An ERP can be formulated around the head and neck cancer patient’s overall journey. Enhanced recovery in colorectal resections: It is essential that anyone dealing with these situations must know what surgery has been performed and whether oral intubation is a feasible alternative.
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. Tumour de-bulking to improve airway patency Whether or not the patient presents as an emergency, there are two objectives. Total laryngectomy is the en bloc removal of the laryngeal structures including the epiglottis, hyoid, and a variable amount of upper trachea. Intra-operative haemoglobin and central venous pressure measurements help in monitoring the need for blood transfusion.
In the case of laryngeal tumours, the most common compromise is to use a small diameter micro-laryngoscopy tube 6. Ideally, any surgeon would wish to have an unrestricted view of the lesion to be operated on.
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, larynectomy intravenous or inhalational. Oxford University Press is a department of the Laryngsctomy of Oxford. The anaesthetist will usually have information about the lesion e. While patients presenting for head and neck surgery may have co-existent problems that could make airway management difficult e.
Laryngeal cancer patients frequently have cardiac and respiratory co-morbidities with limited scope to optimize. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer. Intensive Care Society, Free flaps Attempts have been made to increase the success of free-flap anastomoses by medical means but there is no general consensus as to what if anything is efficacious.
In addition, reference should be made to anticipated airway problems and ensuring the necessary equipment is available. anaesthhesia
Anaesthesia for total laryngectomy.
Colorectal Dis ; Immediately after the procedure, the anaesthetist needs to confirm that the airway will be unobstructed e. All theatre staff are recommended to participate in this initiative to ensure that teams work effectively and that the right patients get the right surgical procedure they have consented to.
The Intensive Care Society has anqesthesia guidelines for the management of tracheostomy and temporary tracheostomy in particular. Even local anaesthesia is not without risk because severe airway obstruction precipitated by laryngospasm has occurred. A guaranteed airway from pre-operative ward care through to safe discharge must be considered as an essential duty of care for any institution undertaking surgery of this nature.
Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines
These alternatives tend to become more of a problem if the operative procedure is prolonged. The need for a covering tracheostomy may have been underestimated. 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 agents.
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. This sort of haemorrhage can arise suddenly and with little warning. 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.
Management of surgical complications Neck haematoma, flap failures, fistulas and airway management issues e. N Engl J Med ; Hypotensive conditions may minimise blood loss and haemodilution is practiced in some institutions with a view to improved blood flow in free flaps.
Acute presentations with stridor require a collaborative approach to the airway that only rarely involves awake fibre-optic intubation.
Management of a post-laryngectomy patient for other procedures. Trans-nasal high-flow rapid insufflation ventilatory exchange or THRIVE delivered anaesthesai a nasal high-flow oxygen delivery system has recently been shown to increase the apnoea time in head and neck patients including those with stridor to an average of 17 minutes.
The Journal of Laryngology and Otology.
Management of elective laryngectomy | BJA Education | Oxford Academic
National Center for Biotechnology InformationU. United Kingdom National Multidisciplinary Guidelines. Trans-nasal high-flow rapid insufflation ventilatory exchange combines apnoeic oxygenation, continuous positive airway pressure and flow-dependent deadspace flushing and has the potential to change the nature of difficult intubations from a hurried stop—start process to a more controlled event, with an extended apnoeic window and reduced iatrogenic trauma.
Anticipated complications include bleeding, tube obstruction and accidental decannulation. Attempts have been made to increase the success of free-flap anastomoses by medical means but there is no general consensus as to what if anything is efficacious. In the post-operative phase, early enteral feeding is advocated.
Currently there is widely diverse practice in terms of post-operative airway management of head and neck cancer patients.