Management of airway in patients with laryngeal tumors

Moorthy, S. S.; Gupta, Sanjay; Laurent, Brynte; Weisberger, Edward C.

doi:10.1016/j.jclinane.2004.12.019

Cited by 64 publications

(38 citation statements)

References 14 publications

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“…The preoperative endoscopic airway examination (PEAE), described by Moorthy6 in 2005, undertaken in operation room by using topical anaesthetic lidocaine, proved to be an optional diagnostic method to evaluate the airway, providing useful information to make the anaesthesia plan, reducing unnecessary tracheotomy and the need for awake intubation 7. But the peroral rigid laryngoscopy, as an indirect endoscopy, performed via the transoral route, can offer only limited view of the postcricoid region, all regions of larynx can only be properly visualised by direct laryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

Misguidance of peroral rigid laryngoscopy in assessment of difficult airway: two comparable cases in microlaryngeal surgery

Zhang¹,

Li²

2013

BMJ Case Reports

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We describe two patients with laryngeal cyst who underwent microlaryngeal surgery. Peroral rigid laryngoscopy, as an indirect endoscopy, performed via the transoral route, was evaluated as a routine screening tool of the difficult airway in patients with laryngeal neoplasm, in our hospital preoperatively. Peroral rigid laryngoscopy had led to two different procedures: One patient was misdiagnosed as having a difficult airway by the ear, nose and throat surgeon resulting in an unnecessary awake tracheotomy. The other patient was found to be with an unanticipated difficult intubation following routine anaesthesia, successful on the third attempt. As we saw in these two cases, endoscopic examination alone was inadequate for the assessment of a difficult airway, which may also lack the predictive sensitivity or may cause a high false positive. Usage of video laryngoscopy combined with intubating stylet will improve the intubation success in patients with huge epiglottic cyst.

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Section: Discussionmentioning

confidence: 99%

Misguidance of peroral rigid laryngoscopy in assessment of difficult airway: two comparable cases in microlaryngeal surgery

Zhang¹,

Li²

2013

BMJ Case Reports

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“…This is an important question, as even in the twenty-first century, many patients with advanced laryngeal cancer present with such severe airway compromise as to require emergency airway management. Though several protocols exist as to how to judge how severely compromised an airway is [12,34], often objective measures of respiratory rate, fatigue, pulse oximetry etc. interplay with subjective measures of stridor and feelings of panic from both the patient and surgeon.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative tracheostomy does not impact on stomal recurrence and overall survival in patients undergoing primary laryngectomy

Pézier

Nixon

Joshi

et al. 2012

Eur Arch Otorhinolaryngol

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Pre-operative tracheostomy (POT) to secure a critical airway up to several weeks before definitive laryngectomy in patients with laryngeal cancer has been proposed as a risk factor for poor oncologic outcome. Few modern papers, however, examine this question. The aim of this study is therefore to determine whether POT affects oncologic outcome with an emphasis on stomal/peristomal recurrence. This is a retrospective case note review of 60 consecutive patients undergoing curative primary total laryngectomy (TL) for advanced laryngeal squamous cell carcinoma (SCC). Demographic, staging, treatment and outcome data were collected. 27/60 (45 %) patients had POT and 33/60 did not. No patient underwent laser debulking. Median age was 62 years (39-90 years) and median follow-up of survivors was 31 months. 5-year overall survival (OS), disease-specific survival (DSS) and local recurrence-free survival (LRFS) of patients undergoing POT versus no POT was 28 versus 39 % (p = 0.947), 55 versus 46 % (p = 0.201) and 96 versus 88 % (p = 0.324) respectively. No statistically significant difference in OS, DSS and LRFS was found between patients undergoing POT and those not. Despite the relatively small case series, this evidence should reassure surgeons without the ability to perform trans-oral debulking that they should not hesitate to perform tracheostomy on a patient with airway obstruction due to laryngeal cancer. Appropriate definitive treatment meant that POT was not a risk factor for poor oncological outcome in our series.

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“…Although awake intubation has been performed in some cases for preventing airway obstruction by induction of general anesthesia and loss of consciousness [5,6], possible complications, such as injury to the tumor, tracheal wall, or upper airway resulting in bleeding, edema, hoarseness, or dysphagia, cannot be completely eliminated [14]. Awake laryngoscopy is recommended only in patients with symptoms such as hoarseness, as reported by Moorthy [15], based on experience in 801 patients with laryngeal tumors.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy

2011

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Primary tracheal tumors are rare in adults, and careful airway management is required during anesthesia for affected patients. We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. During preoperative examination, hemangiomas were detected on the tracheal mucosa. As she was asymptomatic and the degree of airway stenosis was small, treatment was not required for the hemangiomas, and left upper lobectomy for lung cancer was scheduled. After induction of general anesthesia, a regular tracheal tube was inserted under fiberoptic bronchoscopy, with care taken to prevent damage to the hemangiomas. An endobronchial blocker was inserted for one-lung ventilation. The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia and neuromuscular blockade. The mask was removed after confirming lack of bleeding from the hemangiomas. No hypoxia or other complications occurred during or after the operation.

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Management of airway in patients with laryngeal tumors

Cited by 64 publications

References 14 publications

Misguidance of peroral rigid laryngoscopy in assessment of difficult airway: two comparable cases in microlaryngeal surgery

Misguidance of peroral rigid laryngoscopy in assessment of difficult airway: two comparable cases in microlaryngeal surgery

Pre-operative tracheostomy does not impact on stomal recurrence and overall survival in patients undergoing primary laryngectomy

Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy

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