Anaesthesiologic and intensive care particularities in cervical surgery

Abstract

Abstract BACKGROUND. Endotracheal intubation is frequently used to maintain airways proper functioning during elective surgical operations, in intensive care and in emergency rooms. The pathology of the oropharyngeal and laryngeal area or that of the cervical area induces, in most cases, changes in the airways, especially in the sense of their narrowing or deviation. The presence of tumors on the oro-pharyngo-laryngeal axis, some bleeding easily spontaneously or upon touch, can make the anaesthetic procedure difficult. MATERIAL AND METHODS. We conducted a prospective, observational study on 50 patients with cervical pathology who required general anaesthesia during 2019-2021. The criteria and parameters analysed for predicting difficult intubation were the duration of orotracheal or nasotracheal intubation, difficult face mask ventilation, Cormack-Lehane and Mallampati scores, anthropometric determinations of various cervical landmarks, including the thyromental distance, the distance between the arytenoid cartilages and the distance from the plane of the arytenoid cartilages to the skin, both of the latter determined ultrasonographically. RESULTS. The following statistically significant differences emerge from the study: the duration of orotracheal intubation (p<0.001), the difficulty of face mask ventilation (p<0.001), the intercondylar distance (p=0.042), the intermastoid distance (p=0.023), the Cormack-Lehane score (p=0.013), the Mallampati score (p=0.004), the distance between the arytenoid cartilages (p=0.007), the distance between the plane of the arytenoid cartilages and the skin (p<0.001). All were increased in patients with tumoral pathology. CONCLUSION. The study demonstrates the variation of new criteria and parameters that can be analysed for the prediction of a difficult airway, identifies the efficiency of using ultrasound whenever possible in the preanesthetic evaluation of the airway, and quantifies the risk of difficulty in airway management based on anthropometric data, particularly through the occurrence of asymmetry at the cervical or facial level.