Anaesthesia for head and neck cancer surgery

Ahmed-Nusrath, Anjum

doi:10.1093/bjaed/mkx028

Cited by 27 publications

(29 citation statements)

References 20 publications

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“…Other conditions, including the presence of head and neck cancer, arthritis, ankylosing spondylitis, and diabetes with limited joint mobility, which can alter the patient's ability to lie flat are also associated with failed and difficult intubation, due to narrowing of the airway and challenges in positioning during intubation. [26][27][28] In addition, large hospitals with >500 beds were more likely to have documented DI cases, which may reflect more consistent reporting standards often instituted at large hospitals. Although risk factors associated with DI have been identified, prediction of DI is a challenging task, and additional research to understand the predictors for DI would be beneficial, allowing clinicians to choose the appropriate method and device for patient airway management in challenging cases.…”

Section: Discussionmentioning

confidence: 99%

Factors and Economic Outcomes Associated with Documented Difficult Intubation in the United States

Moucharite¹,

Zhang²,

Giffin³

2021

CEOR

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Purpose Establishing good mechanical ventilation is a critical component and prerequisite to a wide range of surgical and medical interventions. Yet difficulties in intubating patients, and a variety of associated complications, are well documented. The economic burden resulting from difficult intubation (DI), however, is not well understood. The current study examines the economic burden of documented DI during inpatient surgical admissions and explores factors that are associated with DI. Patients and Methods Using data from the Premier Healthcare Database, adult patients with inpatient surgical admissions between January 1, 2016 and December 31, 2018 were selected. International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) diagnosis codes were used to classify the patients into matched cohorts of DI and non-DI patients. Results Patients in the DI group have mean inpatient costs and intensive care unit (ICU) costs that are substantially higher than patients without difficult intubations ($14,468 and $4,029 higher, respectively). Mean hospital length of stay and ICU length of stay were 3.8 days and 2.0 days longer, respectively (all p<0.0001, except ICU cost p=0.0001) in the DI group. Obesity, other chronic conditions, and larger hospital size were significantly associated with DI. Conclusion DI is associated with higher average cost and longer average length of stay.

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Section: Discussionmentioning

confidence: 99%

Factors and Economic Outcomes Associated with Documented Difficult Intubation in the United States

Moucharite¹,

Zhang²,

Giffin³

2021

CEOR

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“…The resulting trismus and woody neck[ 6 ] impede mask ventilation and laryngoscopy. [ 29 ] [ Table 2 ]. Subtle changes to voice, dysphagia, orthopnoea and new onset of snoring may be a sign of airway compromise.…”

Section: Discussionmentioning

confidence: 99%

“…More patients in the RT group had trismus (24.8% versus 18.7%). Nusrath[ 29 ] emphasised the need for an 'airway management strategy' in HNC.…”

Section: Discussionmentioning

confidence: 99%

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Head and neck radiotherapy - A risk factor for anaesthesia?

Jain

Joad

2020

Indian J Anaesth

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Background: The aim was to study perioperative management in head and neck cancer, the commonest cancer in Indian men, after radiation therapy. Radiotherapy (RT) targets the tumour and the neck including the thyroid gland. RT induced physical effects (on the airway) and physiological effects (on the thyroid) impact perioperative care. Patients with RT-induced subclinical and mild clinical hypothyroidism are often asymptomatic. Cancer surgery is time-sensitive. Given that parenteral levothyroxine is not available, is a TSH of 15 acceptable for cancer surgery? Methods: A retrospective study was conducted in a tertiary cancer centre. The records of elective surgery (72 patients) were scrutinised. Data on thyroid profile, airway, treatment of clinical and subclinical hypothyroidism, airway access, recovery and perioperative haemodynamic parameters were retrieved. Correlation of age, sex, RT, chemotherapy with hypothyroidism was done by Chi-square test. The perioperative course was studied. Results: Hypothyroidism (subclinical and clinical) was diagnosed in 39% of patients. All were asymptomatic. There was a significant association between RT and hypothyroidism. In 50% of patients, we encountered a difficult airway. In subclinical hypothyroidism (TSH less than 15), after levothyroxine initiation, the course of anaesthesia, extubation, recovery and postoperative stay was uneventful. Conclusions: Hypothyroidism and difficult airways are a common sequel of RT. Selected cancer patients with subclinical hypothyroidism had a smooth perioperative course.

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“…Head and neck cancers of the upper aerodigestive tract may have a significant impact on the airway. 1 The use of advanced cross-sectional imaging modalities has revolutionised diagnosis and management. 2 The role of imaging is important in identifying primary disease site and, alongside endoscopic, operative and pathological findings, in staging extent of the malignancy.…”

Section: Learning Objectivesmentioning

confidence: 99%