Multidisciplinary difficult airway challenges: Perioperative management of glottic and supraglottic tumors

Abstract

Carcinomas of the larynx are common and require multidisciplinary perioperative management, with particularly excellent communication between the surgeon and anesthesiologist. Early preoperative assessment allows for optimization, prehabilitation and advanced imaging in cases who present without respiratory compromise. On arrival for surgery, thorough airway examination including preoperative endoscopic airway assessment under topical anesthesia and airway ultrasound will inform planning for airway management. The fundamental decision between awake tracheal intubation or awake tracheostomy, and intubation after induction of anesthesia should be made as a team, with strategies for failure (such as rigid bronchoscopy or emergency surgical airway) clearly defined, and staff and equipment present. Balanced total intravenous anesthesia with target-controlled infusions allow good analgesia and smooth emergence. Admission to a postanesthesia high care environment is advisable.