Anaesthesia for head and neck cancer surgery

Abstract

Major head and neck cancer surgery presents many specific anaesthetic challenges, with the increased likelihood of a difficult airway and the challenges of the shared airway. It is imperative to have a pre-planned strategy for managing the airway and this requires close liaison and communication between the surgical and anaesthetic teams both for intubation and for extubation. The initial airway plan may still not be successful so the process must be planned all the way through to a potential rescue oxygenation situation. Although useful in many situations, awake fibreoptic intubation is not a panacea for all ills, especially in cases of tight laryngeal stenosis, acute stridor, or a friable tumour prone to bleeding when cricothyroidotomy or tracheostomy under local anaesthesia should also be considered (in conjunction with the ENT surgeons). Intraoperatively, there are other issues to consider and in particular the anaesthetist should maintain a high index of suspicion for venous air embolism and concealed blood loss. The post-operative airway strategy is just as important as intubation and should be planned in advance. Prolonged surgery, swelling and possible post-operative bleeding can all result in airway compromise and intra-operative tracheostomy insertion may be the safest option.