ANAESTHESIA FOR LARYNGECTOMY PDF

  • June 20, 2019

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.

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The anaesthetist will usually have information about the lesion e.

Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines

This is the more usual situation where the risk of airway obstruction is considered less likely. Perioperative management of the elective laryngectomy.

It is essential that anyone dealing with these situations must know what surgery has been performed and whether oral intubation is a cor alternative.

Proximity to the emergency theatres and kit available on the ward should be important considerations. In the case of laryngeal tumours, the most common compromise is to use a small diameter micro-laryngoscopy tube 6. In the post-operative phase, early enteral feeding is advocated. Anaewthesia article has been cited by other articles in PMC. World Alliance for Patient Safety.

For example, at one end of the spectrum almost all free-flap reconstructions are managed with temporary tracheostomy whereas elsewhere, overnight ventilation followed by extubation the following morning is the expected norm.

Management of elective laryngectomy | BJA Education | Oxford Academic

Whether or not the patient presents as an emergency, there are two objectives. Post-operative haemorrhage and oedema risks mean that tracheostomy remains an important consideration in extensive resections. Specific operative considerations The compromised airway In the patient who presents with acute airway compromise the obvious option is to consider a tracheostomy under local anaesthesia.

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.

Tubeless anaesthesia Ideally, any surgeon would wish to have an unrestricted view of the lesion to be operated on. Br J Oral Maxillofac Surg ; 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.

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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. Even this may not be an easy option in the patient who is already desaturated, uncooperative and unable to lie flat. Intra-operative haemoglobin and central venous pressure measurements help in monitoring the need for blood transfusion.

Management of a post-laryngectomy patient for other procedures. Sign In or Create an Account. Close mobile search navigation Article navigation. Because of the need anawsthesia attend to the problem, there will be limited time for radiological imaging. The latter is obviously preferable in patients with subglottic extension of a laryngeal tumour.

Anaesthseia is an Open Access article, distributed under the terms of the Creative Commons Attribution licence http: 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. While patients presenting for head and neck surgery may have co-existent problems that could make airway management difficult e.

Post laryngectomy patients can present for other types of surgery and a clear plan must be made for the management of such patients. The Royal College of Anaesthetists, 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 laryngecfomy mandibular resections where brisk bleeding may occur.

Standardised handover forms are commonly used to summarise surgery and anaesthesia intra-operative events with a description of the resulting airway anatomical configuration and advisory options in the event of potential airway problems. For Permissions, please email: This will vary with the surgery and the anaesthetist’s requirement to avoid airway compromise by way of gas exchange or soiling.

Flap donor sites may have their own analgesic requirements. Anaesthesia for patients with laryngeal cancer. Rigidity and distortion of the oropharyngeal tissues can interfere with facemask ventilation and conventional laryngoscopy. These situations can be very serious both because of the technical challenges posed and the limited time available for re-establishing the compromised airway.

Many of these cases will prove to have a laryngeal tumour, in which case surgeons generally prefer that tracheostomy is avoided. Acute presentations with stridor require a collaborative approach to the airway that only rarely involves awake fibre-optic intubation. 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.

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The risk of airway fires due to laser is low provided careful precautions including laser safe tubes are used. Author information Copyright and License information Disclaimer.

When patients are admitted to a post-anaesthesia care unit with tracheal tubes in place, continuous capnography monitoring is appropriate and their removal remains the anaesthetist’s responsibility.

Cardiac monitoring was used regularly in only 9 per cent of UK units in an audit in laryyngectomy Other alternatives which allow a much less restricted field are: It is unusual for any patient to be ventilated post-operatively. Intensive Care Society, Heliox mixtures may provide symptomatic relief, while further information is obtained, e. General anaesthetic considerations World Health Organization WHO checklist All theatre staff are recommended to participate in this initiative to ensure that anaesthesix work effectively and that the right patients get the right surgical procedure anaesthesa have consented to.

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.

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. In some institutions, ventilation is established prior to induction of general anaesthesia via temporary crico-thyroid or trans-tracheal access. 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.

Anticipated complications include bleeding, tube obstruction and accidental decannulation.

It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Tumour de-bulking to improve airway patency Whether or not the patient presents as an emergency, there are two objectives.