Abstract
BackgroundThe incidence of difficult airway is higher in head and neck oncological surgery than in other surgeries. Limited evidence is available on the use of videolaryngoscopes in this cohort. A registry database on perioperative management of these patients was set up in our department in 2017.MethodsData from 2018 to 2019 were retrieved from this database. In 128 patients, videolaryngoscopy was used as the initial airway management of choice. Ease of intubation by first-pass success, its association with accessory manoeuvres, and complications were noted.ResultsOf the patients, 87% (n = 111) were successfully intubated with a videolaryngoscope in the first attempts. There was a strong association between the use of external laryngeal manipulation and successful first-pass intubation with videolaryngoscope. In patients with reduced inter-incisor distance, videolaryngoscope has shown greater benefit. There were very few complications including bleeding from the tumour site and a transient decrease in oxygen saturation to 88% in two patients.ConclusionVideolaryngoscopy was associated with high first-attempt intubation success and we recommend its use as the initial choice for airway management in head and neck cancer patients.
Highlights
Oral cancer is ranked as the sixth most common cancer worldwide [1] and 40% occur in Southeast Asian countries (India, Sri Lanka, Bangladesh, and Pakistan) [2]
There was a strong association between the use of external laryngeal manipulation and successful first-pass intubation with videolaryngoscope
This study aimed to evaluate the use of videolaryngoscope in patients who presented for head and neck cancer surgery with regards to success, failure, and intubation-related complications
Summary
Oral cancer is ranked as the sixth most common cancer worldwide [1] and 40% occur in Southeast Asian countries (India, Sri Lanka, Bangladesh, and Pakistan) [2]. The incidence of difficult intubation is higher in patients with ear, nose, and throat malignancies than in the general surgical population (15.75% vs 2.5%) [3,4]. The success of conventional laryngoscopy routinely depends on adequate mouth opening, proper head positioning, and consistent anatomy [5]. In head and neck cancer patients, limited mouth opening, poor tissue mobility, airway distortion, and prior radiotherapy increase the failure rate of tracheal intubation with conventional laryngoscopy [6]. Videolaryngoscopy (VL) has improved the success of tracheal intubation in difficult airway management as it produces a view of the laryngeal inlet independent of the line of sight. Limited evidence exists on the use of videolaryngoscope in head and neck cancer [6]. The incidence of difficult airway is higher in head and neck oncological surgery than in other surgeries.
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