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

  • P Charters (a1), I Ahmad (a2), A Patel (a3) and S Russell (a4)

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer.

Recommendations

• All theatre staff should participate in the World Health Organization checklist process. (R)

• Post-operative airway management should be guided by local protocols. (R)

• Patients admitted to post-operative care units with tracheal tubes in place should be monitored with continuous capnography. Removal for tracheal tubes is the responsibility of the anaesthetist. (R)

• Anaesthetists should formally hand over care to an appropriately trained practitioner in the post-operative or intensive care unit. (G)

• Intensive care unit staff looking after post-operative tracheostomies must be clear about which patients are not suitable for bag-mask ventilation and/or oral intubation in the event of emergencies. (R)

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Address for correspondence: Peter Charters, Department of Anaesthesia, University Hospital Aintree, Liverpool, UK E-mail: pete.charters@btinternet.com

References

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1 Robson, A, Sturman, J, Williamson, P, Conboy, P, Penney, S, Wood, H. Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130(Suppl S2):S13–22
2 World Alliance for Patient Safety. WHO Surgical Safety Checklist and Implementation Manual Geneva. Switzerland: WHO Press, World Health Organization, 2008
3 Haynes, AB, Weiser, TG, Berry, WR, Lipsitz, SR, Breizat, AH, Dellinger, EP et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–99
4 Birks, RJS, Gemmell, LW, O'Sullivan, EP, Rowbotham, DJ, Sneyd, JR. Recommendations for Standards of Monitoring During Anaesthesia and Recovery. London: The Association of Anaesthetists of Great Britain and Ireland, 2007
5 Cook, TM, Woodall, N, Frerk, C. Major Complications of Airway Management in the United Kingdom. London: The Royal College of Anaesthetists, 2011
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7 Chalmers, A, Turner, MW, Anand, R, Puxeddu, R, Brennan, PA. Cardiac output monitoring to guide fluid replacement in head and neck microvascular free flap surgery – what is current practice in the UK? Br J Oral Maxillofac Surg 2012;50:500–3
8 Whitaker, DK, Booth, H, Clyburn, P, Harrop-Griffiths, W, Hosie, H, Kilvington, B et al. Immediate post-anaesthesia recovery 2013: association of anaesthetists of Great Britain and Ireland. Anaesthesia 2013;68:288–97
9 Bodenham, A, Bell, D, Bonner, S, Branch, F, Dawson, D, Morgan, P et al. Standards for the Care of Adult Patients with a Temporary Tracheostomy: Standards and Guidelines. Intensive Care Society, 2014. http://www.ics.ac.uk/EasysiteWeb/getresource.axd?AssetID=2212&type=full&servicetype=Attachment (accessed 4th March 2016)
10 Khoo, CK, Vickery, CJ, Forsyth, N, Vinall, NS, Eyre-Brook, IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007;245:867–72
11 Walter, CJ, Collin, J, Dumville, JC, Drew, PJ, Monson, JR. Enhanced recovery in colorectal resections: a systematic review and meta-analysis. Colorectal Dis 2009;11:344–53
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