Original contribution
Management of airway in patients with laryngeal tumors

https://doi.org/10.1016/j.jclinane.2004.12.019Get rights and content

Abstract

Study Objective

To describe our systematic approach to securing the airway in patients with laryngeal tumors, developed over a 10-year period.

Design

Retrospective analysis.

Setting

University-affiliated veterans administration medical center.

Patients

Eight hundred one patients presenting for laryngeal tumor surgery in a 10-year period, 285 of whom underwent tracheostomy (25 with local anesthesia and 260 with general anesthesia).

Interventions

Preoperative examination, including history, physical examination, computed axial tomography and/or magnetic resonance imaging, and ear, nose, and throat surgeons' evaluation via indirect laryngoscopy or fiberoptic bronchoscopy were performed before the anesthesiologist's interventions. Local (topical) anesthesia and mild sedation were used for laryngeal evaluation with fiberoptic bronchoscopy. Tumor grade was then established, which determined how the airway would be secured: general anesthesia induction, receive topical anesthesia for awake, direct laryngoscopy, and tracheal intubation, or undergo tracheostomy with local anesthesia.

Measurements and Main Results

When the airway was secured, surgeons performed the biopsy, (any) tumor debulking, laser excision, or tracheostomy to establish both the airway and the diagnosis. Pulmonary function, including flow-volume loops and blood gas analysis were also useful in evaluating the degree of obstruction and gas exchange. In the event of respiratory distress, tracheostomy was performed after tracheal intubation or with local anesthesia, followed by direct laryngoscopy and biopsy. Depending on the diagnosis, further surgery and radiation treatment were planned next.

Conclusions

With these guidelines, we have reduced the frequency of emergencies because of a lost airway, bleeding, or dislodging of tumor.

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)

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