Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery

Siddiqui, Ali; Dogar, Samie Asghar; Lal, Shankar; Akhtar, Shabbir; Khan, Fauzia Anis

doi:10.4103/0970-9185.173341

Cited by 26 publications

(24 citation statements)

References 19 publications

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“…Such surgical invasions pose a risk of various postoperative complications, including surgical wound infection, necrosis of reconstructed aps, postoperative bleeding, and upper airway obstruction. Postoperative complications may prohibit healing, extend the length of hospital stays, and be life-threatening [1][2][3][4][5]. Notably, the causes of airway obstruction include postoperative hematoma, pharyngolaryngeal edema, and morphological changes of the airway; thus, appropriate airway management is required [6,7].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Abe

Kurita

Ito

et al. 2020

Preprint

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Background: In oral cancer surgery, the decision to tracheotomize is often determined based on the experience of the surgeon. Sometimes, tracheotomy may be performed for cases that may not necessarily require tracheotomy. For such cases, safety is achieved by airway management, but the patients are exposed to tracheotomy-related complications. Several evaluation methods have been reported to predict the need for selective tracheotomy in patients with oral cancer. In this study, we investigated the competency of clinical scoring systems in identifying patients who require tracheotomy among the oral malignancy cases treated with surgery in our department, and examined the degree of agreement between the surgeon’s decision and the scores of various scoring systems. Methods: This study was conducted on 110 patients with oral cancer who were treated with surgery under general anesthesia in the Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, between January 2007 and April 2018. Among them, 67 patients (44 male and 23 female), who were managed by resection and reconstruction, were retrospectively analyzed. To derive the score, we evaluated the endpoint of these indices from clinical records and images. We divided the patients, based on the Cameron and Gupta scores, into two groups: tracheotomy and no tracheotomy groups, and evaluated the degree of agreement by calculating the κ coefficient. Results: After the assessment, the κ coefficients of the Gupta and Cameron scores were 0.61 (95% CI, 0.4-0.82) and 0.6 (95% CI, 0.38-0.82), respectively. The clinical evaluation of the κ coefficient indicated that the Gupta and Cameron scores agreed substantially. Discussion: These score matched the decision of the surgeon and confirmed that it was able to be applied to the decision of the airway management. However, these values are affected by prevalence. When unilateral total neck dissection and resection of the primary lesion were performed, though it was high-risk, the score was low, and an evaluation contradicted it. Conclusions: In this study, the Cameron and Gupta scores agreed with the decision of the experienced surgeon to some extent, and were confirmed to adapt to the clinical judgment.

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Section: Introductionmentioning

confidence: 99%

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Abe

Kurita

Ito

et al. 2020

Preprint

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“…Head and neck cancers are among the top 10 malignancies globally, (7) and most of the patients present with late complications with regard to airway management (8,9). The most common factors associated with cancers are tobacco and gutka chewing, use of pan masala and poor nutrition (7,10). Oral cancer is the main component of head and neck cancers.…”

Section: Discussionmentioning

confidence: 99%

Airway Management of Patients Undergoing Oral Cancer Surgery: A Retrospective Analysis of 156 Patients

Nikhar¹,

Sharma²,

Ramdaspally³

et al. 2017

Turk J Anaesth Reanim

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Objective: Oral cancer patients have a potentially difficult airway, but if managed properly during the perioperative period, morbidity and mortality can be reduced or avoided. Methods:The medical records of 156 patients who were operated for oral cancers were reviewed for airway management during the perioperative period. Results:The surgical procedures ranged from excisions, wide local excisions with split skin graftings, hemiglossectomies and radical neck nodes dissections to pectoralis major myocutaneous or free fibular flaps. Intubation was assessed as difficult in 14.7% of patients because of tumour-or radiation fibrosis-related trismus, restricted neck mobility and prior similar surgeries. Twenty patients had undergone surgery for oral cancer previously and were scheduled for flap reconstruction. Nasotracheal intubation was a preferred route, and 62.8% of patients could be intubated nasotracheally after neuromuscular blockade. Tracheostomy (elective or existing) was utilised for airway control in 19.2% cases. Patients who had undergone prior radiotherapy were more likely to be tracheostomised. McCoy laryngoscopes (13.4%), gum elastic bougies (23.6%), Airtraq devices (0.006%) and fibreoptic bronchoscopes (FOBs) (0.03%) were the additional airway techniques employed. In total, 64 patients (50.7%) could be extubated immediately after surgery. Conclusion:Proper preoperative evaluation and planning help manage difficult airways effectively with minimal need of advanced airway gadgets. Gum elastic bougies and Magill forceps are very useful in airway management and decrease the need of elective tracheostomy in oral cancer patients. Keywords: Oral cancer, surgery, airway managementAmaç: Ağız kanseri hastaları potansiyel olarak zor bir havayoluna sahiptirler. Ancak, ameliyat süresince doğru bir şekilde yönetilirse, morbidite ve mortalite düşürülebilir veya önlenebilir.Yöntemler: Ağız kanseri nedeniyle ameliyat edilen 156 hastanın tıbbi kayıtları perioperatif dönemde havayolu yönetimi açısından incelendi. Bulgular:Cerrahi işlemler eksizyon, parsiyel kalınlıkta deri greftleri, hemiglossektomiler, radikal boyun nodu diseksiyonlarından pektoralis majör miyokutan veya serbest fibular fleplere değişiklik göstermiştir. Entübasyon hastaların %14,7'sinde, tümör veya radyasyon fibrozisiyle ilgili trismus, sınırlı boyun hareketliliği ve daha önceden yapılmış ameliyatlardan dolayı zor olarak değerlendirildi. Yirmi hasta daha önce ağız kanseri nedeniyle ameliyat edilmişti ve flep rekonstrüksiyonu planlandı. Nazotrakeal entübasyon tercih edilen bir yöntemdi ve hastaların %62,8'i nöromusküler blokaj sonrasında nazotrakeal olarak entübe edilebildi. Vakaların %19,2'sinde havayolu kontrolü için trakeotomi (elektif ya da mevcut) kullanıldı. Daha önce radyoterapi alan hastalarda trakeotomi ameliyatı olma olasılığı daha yüksek olarak bulundu. McCoy laringoskoplar (%13,4), gum elastik bujiler (%23,6), Airtraq cihazlar (%0,006) ve fiberoptik bronkoskoplar (FOBs) (%0,03) kullanılan diğer havayolu teknikleriydi. Toplamda 64 hasta (%50,7) ...

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“…Surgery or radiation therapy alone or a combination of these treatments may be part of a patient's treatment plan [53]. Tracheostomy is performed when there are concerns about breathing due to airway obstruction associated with a throat cancer or treatment side efects [54]. Nutritional status of patients declines following tracheostomy.…”

Section: Treatmentmentioning

confidence: 99%

Physical Therapy in Patients with Cancer

Morishita¹,

Tsubaki²

2017

Clinical Physical Therapy

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Physical therapists often treat cancer patients. Cancer treatment includes chemotherapy, radiotherapy, and surgery, which are being continuously developed and thus increase survival of patients with each cancer diagnosis. More speciically, 5-year survival rates increase with each cancer diagnosis. Cancer patients have many problems including muscle weakness, pulmonary dysfunction, fatigue, and pain. In the end, patients with cancer tend to have a decline in activities of daily living (ADL) and quality of life (QOL). Additionally, cancer patients often have progressive disease, depression, and anxiety. Physical therapy often helps patients regain strength and physical function and improve their QOL and independence of daily living that they may have lost due to cancer or its treatment. Physical therapy has an important role in increasing physical function of cancer patients, cancer survivors, and children with cancer. In the future, physical therapy may be progressively needed for management of cancer patients.

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Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery

Cited by 26 publications

References 19 publications

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Airway Management of Patients Undergoing Oral Cancer Surgery: A Retrospective Analysis of 156 Patients

Physical Therapy in Patients with Cancer

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