Principles of Adult Anesthesia in Head and Neck Surgery
25th International Rhinocamp Congress, Muğla, Türkiye, 25 - 29 Mayıs 2022, ss.134-135, (Tam Metin Bildiri)
- Yayın Türü: Bildiri / Tam Metin Bildiri
- Basıldığı Şehir: Muğla
- Basıldığı Ülke: Türkiye
- Sayfa Sayıları: ss.134-135
- Erzincan Binali Yıldırım Üniversitesi Adresli: Hayır
Özet
Principles of Adult Anesthesia in Head and Neck Surgery
Tülay Ceren Ölmeztürk Karakurt MD
Erzincan Binali Yıldırım University, Mengücek Gazi Training and Research Hospital, Anesthesiology and Reanimation Department, Erzincan - Turkey
The spectrum of head and neck surgery is broad, ranging from simple procedures, such as tonsillectomy to precision
laryngologic, neurotologic, and skull-base surgery, complex obstructive sleep apnea (OSA) surgery, thyroid and
major head and neck cancer surgery. General anesthesia is the technique of preference for most head and neck
surgery procedures. With general anesthesia, amnesia is reliably provided, the patient's airway is protected, adequate
gas exchange is ensured, and patient movement is eliminated. Standard American Society of Anesthesiologists
(ASA) monitors (eg, blood pressure, electrocardiography, O2 saturation, capnography, and temperature) are usually
sufficient during head and neck surgery.
A medical history and physical examination should be performed for all patients who undergo anesthesia. In patients
scheduled for head and neck surgery, we should focus preoperative evaluation on the airway and medical conditions
associated with complications during these procedures.
Controlled hypotensive techniques should be avoided in patients with cerebrovascular disease, coronary artery
disease, uncontrolled hypertension, chronic renal failure or advanced liver disease. Intraoperative hypotension
should be treated aggressively. Patients with lung disease may not be suitable for spontaneous ventilation, apneic
intermittent ventilation or jet ventilation techniques.
Obstructive sleep apnea (OSA) is common in patients undergoing head and neck surgery and may be undiagnosed.
Patients with OSA are more sensitive to sedatives and opioids. Patients are prone to airway obstruction during
anesthesia induction and postoperative period.
In neurotologic patients, lower cranial nerve involvement (cranial nerves X, XI, and XII) may increase the risk of
aspiration or airway obstruction by induction of anesthesia and complicate airway management.
The following issues are of particular concern in patients with head and neck cancer:
Most cases are associated with tobacco and alcohol use predisposing to cardiopulmonary, liver and other comorbidities
that may affect anesthesia management.
Patients are often anemic. Hemoglobin, hematocrit, and electrolytes should be measured preoperatively in addition
to other laboratory tests.
Radiation; may cause dry mouth, airway edema, dysphagia, inadequate oral intake and dehydration. This may
predispose patients to hypotension with induction of anesthesia. It can also cause tissue fibrosis, limited mouth
opening and neck extension, and glottic and epiglottic edema, making tracheal intubation and mask ventilation
difficult.
Difficulties with airway management are more common in patients undergoing head and neck surgery than
in many other surgical patients. The focus should be on airway management and previous anesthesia records
should be reviewed. Comprehensive preoperative airway assessment should include evaluation of predictors of
difficult/impossible mask ventilation, their relationship to difficult direct laryngoscopy and predictors of difficult
videoingoscopy. A prior easy intubation does not guarantee subsequent uneventful airway management.
In patients who will undergo head and neck surgery, airway management may be impaired after single or especially
repeated interventions in direct laryngoscopy. Head end neck tumors can cause airway distortion and can be
friable, leading to bleeding, fragmentation, airway soiling, and rapid edema formation with laryngoscopy. If direct
laryngoscopy is chosen as the primary approach to tracheal intubation, multiple attempts should be avoided to avoid
total airway obstruction.
Airway is shared by the anesthesiologist and surgeon during the case. For most cases, immediate access for the
anesthesiologist to the patient's airway is either difficult or impossible.
13425th R hino c amp Meeting Proceedings
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During oral and intranasal surgery, the airway must be protected from blood, debris, and irrigation fluid; this may
require the placement of a throat packing. Endotracheal tubes should be suitably sized and sufficiently fixed.
Nasal intubation is required for base of tongue surgery, parotidectomy, transoral robotic surgery, orthognathic surgery,
and maxillomandibular advancement for obstructive sleep apnea. A nasal endotracheal tubes must be appropriately
sized to assure adequate depth of tracheal placement to avoid circuit leak and must be properly secured to prevent
pressure against the nasal ala.
A small size endotracheal tube is usually used for microlaryngeal surgery. In these cases, the endotracheal tube
should be moved to the left corner of the patient's mouth to facilitate the insertion of surgical instruments. It should
be securely fixed to the lower jaw to prevent outward displacement of the endotracheal tube when the mouth is
opened and the neck is extended.
A completely immobile surgical field is required for precise dissection in head and neck surgery (for example, otologic
and neurotologic surgery, laser ear nose and throat surgery, functional endoscopic and cranial floor surgery). Patient
movement, monitor-related movements (blood pressure cuff inflation) and operating room table movements should
be avoided in these situations. The surgeon should be informed before performing any procedure that may prevent
sensitive surgery.
Airway fire risk and prevention should be discussed openly with preoperative surgical and operating room nurses,
and a "laser break" should be observed in the operating room.
Keywords: Principles of Anesthesia, Head and Neck Surgery, Adult
References:
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anclin.2015.02.002
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