Laryngectomy

airway trauma closed loop communication icu laryngectomy shared airway Jun 20, 2024

🌟 What and why? 🌟
A laryngectomy involves surgical excision of the larynx. The tracheal inlet is sutured to the front of the neck. Often performed for laryngeal cancer, but may also be performed in trauma or as a result of radiation damage or chronic infection.

🔍 Intraoperative considerations: 🔍
📍 Position: Supine, head ring +/- pad under shoulders
⏱️ Duration: 3-4 hours
🌬️ Airway plan: Patients are usually intubated via the mouth to start the case. This may involve an awake intubation. Cuff deflation and retraction occur when the new tracheal inlet is formed. A reinforced ETT (sometimes a longer version) is inserted into the tracheal inlet, allowing the surgeons to work around it safely. This is usually switched to a short tracheostomy tube at the end of the case.

💡 Expert tips:
Closed-loop communication is essential during the transition of the airway. Once a laryngectomy has been performed, the patient can no longer be oxygenated via the mouth. Oxygenation via the healed laryngectomy site can be achieved with a paediatric facemask applied to the neck, or by inserting a cuffed ETT into the stoma site.

🌟 Postoperative considerations: 🌟
💥 Pain: Moderate-severe. Often remain ventilated in ICU postoperatively.
❗ Airway risks: Airway irritation can result in coughing. Bleeding/swelling may result in return to theatre.

🔄 Other:
Humidification of oxygen is important, as the patient’s upper airways are no longer providing natural humidification.

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Ref: Turner, Grant, 'Ear, nose and throat surgery', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford, 2022; online edn, Oxford Academic, 1 Nov. 2021)



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