70 - Anesthesia for Otolaryngologic and Head-Neck Surgery

Abstract

Anesthesia for Otolaryngologic and Head-Neck Surgery requires close co-operation between anesthesiologist and surgeon with an understanding of shared airway problems and difficult airway management. A thorough preoperative evaluation should be undertaken to assess for obstructive sleep apnea, snoring, history of prolonged tobacco and alcohol use, and a history of head and neck radiation for malignancy. A preoperative endoscopic airway examination (PEAE) in selected patients provides information on laryngeal disorders and supraglottic pathology. Reviewing the results of CT and MRI scans preoperatively provides useful information on the pathological features likely to produce airflow obstruction or complicate tracheal intubation. Awake Tracheal Intubation (ATI) using flexible bronchoscopy or videolaryngoscopy in selected patients predicted to be difficult to intubate conventionally may be required. In selected patients the airway may be so distorted that awake tracheal intubation is impractical and a tracheostomy under local anaesthetic may be the only option for airway management. Shared airway procedures involving surgery of the glottis, subglottis and trachea require an understanding of specialist equipment, techniques and laser safety. Oropharyngeal and nasopharyngeal throat packs should be placed gently and and accounted for at the end of the procedure. Inspection of the oral cavity with suction clearance of blood, clots and debris should be undertaken at the end of the procedure to prevent possibly fatal aspiration of blood clots on emergence.