Abstract

Studies have demonstrated that poor assessment and planning contribute to airway complications and that current airway assessment strategies have a poor diagnostic accuracy in predicting difficult intubation in the general population. There is a higher risk for difficulties during airway management in patients with pathologies arising from the head and neck region and are more likely to need emergency surgical access. Therefore, thorough assessment and adequate knowledge about the various head and neck pathologies is mandatory. In this chapter, we will briefly go through the preoperative assessment and history & clinical assessment, the investigations. Also we will discuss the airway management at various pathologies involving the head and neck region whether benign/malignant pathologies, OSA (obstructive sleep apnea) and post head & neck operative airway management.

Highlights

  • Working with our anesthesia colleagues at one place which is the upper airway passages is one of the most important aspects of successful laryngeal operation

  • Mask induction with anesthetic agents is the suitable method of airway management for endoscopic treatment of subglottic/tracheal stenosis, or using total intravenous anesthesia (TIVA) using jet ventilation

  • The difficulties and challenges in the airway management of surgical patients with head and neck malignancies are primarily secondary to distortion of normal anatomy and alteration of the normal physiology of upper airways

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Summary

Introduction

OSA is considered one of the important challenges in the peri-operative airway management. Obstructive apneas are defined as complete or near-complete cessation of airflow lasting for at least 10 sec. Obstructive hypopneas are characterized by at least 30% reduction in airflow for a minimum of 10 sec and are associated with a 4% oxygen desaturation [18]. The difficult airway in OSA patients is considered to be a main contributing factor to the higher rate of adverse respiratory and cardiovascular events, so to reduce the peri-operative complication [19], it is better to divide the management approach of OSA patients into: preoperative, intraoperative, and postoperative strategies

Preoperative assessment
History and clinical examination
Pre-operative imaging and endoscopy
CT virtual endoscopy
Airway endoscopy and trans-nasal tracheoscopy (TNT)
In case of the patient has a tracheostomy tube
Anesthesia technique used in case of micro-laryngoscopy (MLS)
Jet Venturi ventilation
Apneic technique using high flow nasal cannula (HFNC)
STRIV-Hi technique
Synopsis
Recognition of the difficult airway
Common airway pathology that indicates difficult airway
Factors affecting the strategy of airway management
How to predict postoperative airway difficulty
Management strategy for difficult airway
Postoperative airway problems
Key points
Pre-operative assessment in suspected OSA patients
Intra-operative assessment and impact of anesthesia on OSA patients
Post-operative assessment
Highlights and pearls for upper airway mangament with elective surgery in adult OSA patients
Findings
Conclusion
Full Text
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