Anesthesia for Head and Neck Surgery

The unique surgical demands and characteristics of patients undergoing head and neck surgery have led to the gradual development of the subspecialty of Head and Neck Anesthesia. The expansion of the surgical specialties of otolaryngology, maxillofacial surgery, dentistry, neurotology, and facial plastic surgery in academic medical centers has led to a corresponding increase in and development of anesthetic expertise. Communication and teamwork are essential for the safe performance of any surgical procedure, but are of particular importance during operations that require the surgical and anesthesia teams to share the patient’s airway. Furthermore, multiple pathologic processes and surgical requirements may result in an increased incidence of difficulty encountered during airway management. As a result, providers specializing in this work require additional skill and experience in advanced airway management techniques such as awake flexible endoscopic intubation, jet ventilation, and transtracheal oxygenation. Many head and neck procedures have unique and challenging requirements for anesthesia care beyond airway management. Patients undergoing oncologic surgery of the head and neck often have comorbidities related to smoking, particularly ischemic heart disease, vasculopathies, and chronic obstructive pulmonary disease. This chapter provides a practical review of the anesthesia skills required for a variety of operations on the head and neck. It emphasizes patient safety, exploring preoperative airway risk assessment, and the prevention of avoidable complications such as intraoperative fire.