Abstract
BackgroundMajor neck surgery is done typically under general anesthesia (GA). The neural blocks of the neck include blocking of the cervical plexus, superior laryngeal nerve, trans-laryngeal, block of the glossopharyngeal nerve, and local anesthetic infiltration. In patients with a high risk of GA, including those with pulmonary dysfunction, and prior myocardial ischemia or infarction, regional anesthesia is mainly indicated.Case presentationWe record a case of a comorbid geriatric patient with dysphonia and left glottic mass that was diagnosed as squamous cell papilloma by transoral biopsy using curved biopsy forceps under local spray anesthesia, and after 6 months, this patient developed stridor for which tracheostomy, laryngofissure, and left cordectomy were then performed solely under neck blocks. Surgery was performed while the patient remained pain-free and stable without any morbidity throughout the operation.ConclusionsIn high-risk patients and low-resource health systems, regional anesthesia in neck surgery can be a reasonable and cheap alternate to general anesthetics.
Highlights
Major neck surgery is done typically under general anesthesia (GA)
General anesthesia (GA) is widely applied in neck operations, but patients with head and neck cancer and some other elderly patients often suffer from Chronic obstructive pulmonary disease (COPD), coronary atherosclerosis, and other comorbidities which together with the risks of arrhythmogenic inhalation anesthetics and assisted ventilation during general anesthesia make them at high risk of general anesthesia up to be considered as non-operable cases
This paper aims to explain the procedure, indications, and limits of using neck Regional anesthesia (RA) alone in highly comorbid patients as a safe alternative to GA, we present a case of huge left glottic papilloma presented with dysphonia and stridor with extreme comorbidities in which tracheostomy laryngofissure and cordectomy were done under a regional block
Summary
General anesthesia (GA) is widely applied in neck operations, but patients with head and neck cancer and some other elderly patients often suffer from COPD, coronary atherosclerosis, and other comorbidities which together with the risks of arrhythmogenic inhalation anesthetics and assisted ventilation during general anesthesia make them at high risk of general anesthesia up to be considered as non-operable cases. CT neck showed a huge mass arising from the left vocal cord filling the glottis and subglottic area without cartilage invasion (Fig. 2). We decided to do tracheostomy under a bilateral cervical block, bilateral superior laryngeal block, translaryngeal, and local infiltration anesthesia. Anesthesia technique After intensive patient counseling about his morbidities and the risks of general anesthesia and getting informed written consent from him about the plan of anesthesia and the surgery and checking normal coagulation profile, the procedure was done using bilateral superficial cervical plexus block under ultrasound guidance where the patient was in the dorsal position, with his cranium tilted to either side for the bilateral block. Of 3 l/min through tracheostomy with no need for adjuvant anesthesia or analgesia; as surgery ends, the patient is discharged to the recovery room for follow-up. The postoperative period was uneventful with no nausea or vomiting, and the need for postoperative analgesia was approximately after 6 h following the surgery which was achieved with a combination of ketorolac and paracetamol
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