Original contributionManagement of airway in patients with laryngeal tumors
Introduction
Patients with laryngeal tumors can present a challenge to secure the airway for their surgeries such as biopsy, debulking of the tumor, laser excision of the tumor, and tracheostomy. Tumors of the larynx include papillomas, carcinomas (CAs), sarcomas, chondromas, hemangiomas, and other lesions. The most common tumors in our patient population are squamous cell CAs. Extensive review of head and neck cancers are addressed in the literature [1]. The incidence of CA of larynx is about 1% of all cancers. In addition, cysts in the glottic area may be encountered, which also impede tracheal intubation.
Preoperative examination and evaluation before an anesthesiologist's intervention are important in the management of these patients, as induction of general anesthesia will result in potential total obstruction of the airway [2], [3].
We have developed a systematic approach to secure the airway in 801 patients with laryngeal tumors undergoing direct laryngoscopy and biopsy over a period of 10 years. Of these patients, 285 had tracheostomies and only 25 had tracheostomies under local anesthesia and the rest under general anesthesia after securing the airway. This is not a study but a clinical experience of the authors. As this approach proved to be useful and prevented panic situations of compromised airway, we are presenting this experience.
Section snippets
Materials and methods
Preoperative examination of these patients included history, physical examination, and indirect laryngoscopy, computed axial tomography (CAT) scan and/or magnetic resonance imaging (MRI). History of hoarse voice, smoking, shortness of breath, and difficulty in swallowing were determined as all may be symptoms of throat pathology. In addition, evaluation of the airway for anatomic abnormalities such as temporomandibular joint dysfunction, short neck, abnormal cervical spine, large tongue,
Discussion
We present our experience in 801 patients over a period of about 10 years. The report is more an evolved methodology of practice than a formal study of patients with laryngeal tumors. The most common groups of patients were grade 1, grade 2a, and grade 2b. Grade 3 patients presented the greatest challenge. These patients were brought to the OR for diagnosis, debulking, laser excision of the tumor, and/or tracheostomy before the definitive treatment.
The steps in our practice are history and
Conclusion
We present our experience in the management of patients with laryngeal tumor over the last 10 years. We proceed in a systematic way to secure the airway for surgery. Patient's history, physical examination, CAT scan or MRI findings, and ENT surgeons' evaluation by indirect laryngoscopy or fiberoptic endoscopy are important before the anesthesiologist's intervention. The surgeons are in the OR, ready to perform tracheostomy if there is a need to secure the airway emergently. We use local
References (14)
- et al.
Diagnostic assessment of laryngeal cancer
Otolaryngol Clin North Am
(2002) Treatment of the patient with upper airway obstruction caused by cancer of the larynx
Otolaryngol Head Neck Surg
(1999)Upper airway obstruction: an avoidable cause of death?
Oper Tech Otolaryngol Head and Neck Surg
(1992)- et al.
Operative evaluation of airway obstruction
Otolaryngol Clin North Am
(1995) - et al.
Anesthetic and operative management of potential upper airway obstruction
Arch Otolaryngol
(1978) - et al.
A clinical sign to predict difficult tracheal intubation: a prospective study
Can Anaesth Soc J
(1985) - et al.
Obstructing tumors of the subglottic larynx and cervical trachea: airway management and treatment
Ann Otol Rhinol Laryngol
(1988)
Cited by (48)
Awake nasotracheal intubation with a 300-mm working length fiberscope: a prospective observational feasibility trial
2023, Brazilian Journal of Anesthesiology (English Edition)Tubeless Thoracic Procedures
2021, Cohen's Comprehensive Thoracic AnesthesiaMultidisciplinary difficult airway challenges: Perioperative management of glottic and supraglottic tumors
2020, Operative Techniques in Otolaryngology - Head and Neck SurgeryCitation Excerpt :With a small-diameter flexible scope, it is well tolerated by patients, as they have frequently already undergone the procedure in the clinic. Grading of the airway by endoscopic view as per the five categories of Moorthy et al (Table 1) can be useful for documentation, communication and guiding decisions on an airway strategy.22 While this may be perceived to be an additional step which will result in delays, it has been shown in a prospective study to reduce the number of awake intubations which are required (in favor of performing video laryngoscopy under anesthesia) while improving patient safety.19
Airway management in laryngeal surgery
2019, Operative Techniques in Otolaryngology - Head and Neck SurgeryA Grading System for Transnasal Flexible Laryngoscopy
2019, Journal of VoiceCitation Excerpt :The management strategy for securing the airway depends on evaluating the upper airway and diagnosing possible anatomic variations that may lead to airway failure risk during the endotracheal intubation. TFL is widely available and a familiar technique for the anesthesiologist to evaluate the upper airway before providing airway management decisions to laryngology patients.13–15 It can help anesthesiologists to choose the proper management strategy.
Airway management: Utilizing radiologist expertise and neuroimaging with head and neck masses
2017, Journal of Clinical Anesthesia