Airway assessment and management in head and neck cancer surgery.

Chiara Mossinelli, Giacomo Pietrobon, Stefano Zorzi, Marta Tagliabue, Francesco Chu, Emilia Tomarchio, Daniele Sances, Marco Venturino, Mohssen Ansarin
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Abstract

Objectives: Head and neck cancer surgery (HNCS) is burdened by a great risk of difficult airway and adverse events during anaesthesia. This study describes our experience and provides a flowchart for airway management in HNCS.

Methods: We retrospectively reviewed 910 surgically treated patients (January 2022- January 2023, European Institute of Oncology, Milan, Italy). We selected malignant tumours of the upper airway and surgery performed under general anaesthesia. We report a descriptive analysis of the sample. The data collected were representative of our daily clinical practice and have been used to draw up a proposal for airway management in HNCS.

Results: 200 consecutive patients (males 71.5%, females 28.5%), median age 67 years, were selected. The most represented sites were larynx (44.5%), oral cavity (30.5%), and oropharynx (20%). Airway management was obtained by orotracheal intubation (61%), nasotracheal intubation (15%), awake intubation under fibreoptic endoscopic control (15%), and tracheostomy under local anaesthesia (9%). In 3 cases we performed tracheostomy in an emergency setting (all patients affected by laryngeal cancer in a locally advanced stage).

Conclusions: Airway management in HNCS represents a topic of compelling interest that requires careful planning, well-defined options of strategies, and close communication between anaesthesiologists and surgeons.

头颈癌手术中气道评估与管理。
目的:头颈癌手术(HNCS)在麻醉期间气道困难和不良事件的风险很大。本研究描述了我们的经验,并提供了HNCS气道管理流程图。方法:我们回顾性分析了910例手术治疗患者(2022年1月- 2023年1月,意大利米兰欧洲肿瘤研究所)。我们选择了在全身麻醉下进行的上呼吸道恶性肿瘤和手术。我们报告对样本的描述性分析。收集的数据代表了我们的日常临床实践,并已用于起草HNCS气道管理建议。结果:连续入选200例患者(男性71.5%,女性28.5%),中位年龄67岁。最具代表性的部位是喉部(44.5%)、口腔(30.5%)和口咽部(20%)。气管插管(61%)、鼻气管插管(15%)、纤维内镜下清醒插管(15%)和局部麻醉下气管造口术(9%)进行气道管理。3例急诊气管切开术(均为局部晚期喉癌患者)。结论:HNCS的气道管理是一个引人注目的话题,需要仔细的计划,明确的策略选择,以及麻醉师和外科医生之间的密切沟通。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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