Hostname: page-component-848d4c4894-8bljj Total loading time: 0 Render date: 2024-06-19T03:34:48.174Z Has data issue: false hasContentIssue false
  • English
  • Français

Airway management of patients undergoing oral cancer surgery: a retrospective study

Published online by Cambridge University Press:  29 June 2005

S. Mishra ,
S. Bhatnagar ,
R. R. Jha  and
A. K. Singhal
S. Mishra
Affiliation:
All India Institute of Medical Sciences, Institute Rotary Cancer Hospital, Unit of Anaesthesiology, New Delhi, India
S. Bhatnagar
Affiliation:
All India Institute of Medical Sciences, Institute Rotary Cancer Hospital, Unit of Anaesthesiology, New Delhi, India
R. R. Jha
Affiliation:
All India Institute of Medical Sciences, Institute Rotary Cancer Hospital, Unit of Anaesthesiology, New Delhi, India
A. K. Singhal
Affiliation:
All India Institute of Medical Sciences, Institute Rotary Cancer Hospital, Unit of Anaesthesiology, New Delhi, India
Get access

Extract

Summary

Objective: This retrospective study aims to describe the airway management and benefits of nasotracheal intubation over tracheostomy in 260 patients with oral cancer undergoing surgery. Methods and Results: The medical records of 260 patients undergoing surgery for oral cancer were reviewed for airway management during the perioperative period. Eighteen patients had previous surgery for oral cancer and were scheduled for flap reconstruction, recurrence or other complications. In 28 cases neck movement was restricted and decreased mouth opening was found in 50% of all patients because of a large growth or fixation of tissues of head and neck, oral cavity, pharynx or larynx by tumour, or radiation fibrosis. In 53 patients intubation was undertaken under spontaneous ventilation. In 20 cases the trachea was extubated in the immediate postoperative period. In 220 cases patients were extubated next morning in the intensive care unit. In none of the cases was elective tracheostomy under local anaesthesia performed before surgery for the maintenance of the airway for anaesthesia. Elective tracheostomies were done in 17 cases. Three patients remained intubated for 24–48 h because of a high suspicion of airway obstruction following extubation due to a large pectoralis major flap. These three patients received a tracheostomy because of increased oropharyngeal and laryngeal oedema. In three cases emergency tracheostomies were performed due to upper airway obstruction after extubation and in one case prolonged elective ventilation was required due to severe chest infection. Conclusion: Oral cancer patients have a potentially difficult airway but, if managed properly during perioperative period, morbidity and mortality can be reduced or avoided. Oral cancer patients can be managed safely without the routine use of a tracheostomy. Nasotracheal intubation is a safe alternative to tracheostomy in oral cancer patients except in some selected patients.

Keywords

INTUBATION INTRATRACHEAL, complications, difficultTRACHEOSTOMYMOUTH NEOPLASMS, oral carcinomaAIRWAY MANAGEMENT, difficult airwayANAESTHESIA TECHNIQUE, inhalation, intravenous
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 7 , July 2005 , pp. 510 - 514
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mehta S, Sarkar S, Kavarana N, Bhathena H, Mehta A. Complications of the pectoralis major myocutaneous flap in the oral cavity: a prospective evaluation of 220 cases. Plast Reconstr Surg 1996; 98: 31–37.Google Scholar
Dougherty TB, Clayman GL. Airway management of surgical patients with head and neck malignancy. Anesthesiol Clin North Am 1998; 16: 547–562.Google Scholar
Supkis DE, Dougherty TB, Nguyen DT, Cagle CK. Anesthetic management of the patients undergoing head and neck cancer surgery. Int Anaesthesiol Clin 1998; 36: 21–29.Google Scholar
Burtner DD, Goodman M. Anaesthetic and operative management of potential upper airway obstruction. Arch Otolaryngol 1978; 104: 657–661.Google Scholar
Mason RA, Fielder CP. The obstructed airway in head and neck surgery. Anaesthesia 1999; 54: 625–628.Google Scholar
Shaw IC, Welchew EA, Harrison BJ, Michael S. Complete airway obstruction during awake fiberoptic intubation. Anaesthesia 1997; 52: 582–585.Google Scholar
McGuire G, Beheiry H. Complete upper airway obstruction during awake fiberoptic intubation in patients with unstable cervical spine fractures. Can J Anaesth 1999; 46: 176–178.Google Scholar
Bonner S, Taylor M. Airway obstruction in head and neck surgery. Anaesthesia 2000; 55: 288–307.Google Scholar
Nandi PR, Charlesworth CH, Taylor SJ, Nunn JF, Dore CJ. Effect of general anaesthesia on the pharynx. Br J Anaesth 1991; 66: 157–162.Google Scholar
Mathru M, Esch O, Lang J et al. Magnetic resonance imaging of the upper airway. Effects of propofol anesthesia and nasal continuous positive airway pressure in humans. Anaesthesiology 1996; 84: 253–255.Google Scholar
Crosher R, Baldie C, Mitchell R. Selective use of tracheostomy in surgery for head and neck cancer: an audit. Br J Oral Max Surg 1997; 35: 43–45.Google Scholar
Alberti PW. Tracheostomy versus intubation: a 19th century controversy. Annals Otol Rhinol Laryngol 1984; 93: 333–337.Google Scholar
Halfpenny W, McGurk M. Analysis of tracheostomy- associated morbidity after operations for head and neck cancer. Br J Oral Max Surg 2000; 38: 509–512.Google Scholar
Berlauk JF. Prolonged intubation vs tracheostomy. Crit Care Med 1986; 14: 742–745.Google Scholar
Bowes JB, Kelly DF, Peacock J. Intubation trauma. Anaesthesia 1973; 28: 603–610.Google Scholar
Agnew J, Hains D, Rounseell B. Management of the airway in oral and oropharyngeal resections. Aust NZ J Surg 1992; 62: 652–653.Google Scholar
Scher N, Dobleman TJ, Panje WR. Endotracheal intubation as an alternative to tracheostomy after intraoral or oropharyngeal surgery. Head Neck 1989; 11: 500–504.Google Scholar
Castling B, Telfer M, Avery S. Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases. Br J Oral Max Surg 1994; 32: 3–5.Google Scholar