الفهرس | Only 14 pages are availabe for public view |
Abstract Laryngeal carcinoma is one of the common malignancies of the head and neck. Incidence is higher in males than females, and it is more affecting patients in 60 to 70 years old. More than 90% of laryngeal cancer is squamous cell carcinoma (SCC), and is directly linked to smoking and excessive alcohol use. Total laryngectomy continues to play a major role in the treatment of advanced laryngeal cancer or for recurrent/persistent disease after failed organ preservation attempts. Laryngeal cancer patients are a great challenge and they need meticulous evaluation preoperative and special measures intraoperative and of course close observation and management postoperative. The general condition of the patients is one of the most important points during the management. Those patients mostly are elderly smokers with many associated comorbidities such as ischemic heart diseases, chronic obstructive pulmonary diseases, diabetes mellitus, impairment of renal and hepatic functions, nutritional and psychological problems and notably their preoperative treatment by radiotherapy and chemotherapy with their associated undesired side effects. All of this demands special consideration and perioperative management. Patient‟s history, physical examination, CT scan or MRI findings, and ENT surgeons‟ evaluation by indirect laryngoscopy or fiberoptic endoscopy are important before the anesthesiologist‟s intervention. Airway management may be the major dilemma in these patients. Establishing, maintaining and protecting an airway in the face of abnormal anatomy due tumor and simultaneous surgical intervention can be challenging. All airway techniques need back-up plans. Adequate assessment to identify the site and level of obstruction, in particular with nasendoscopy, CT and MRI imaging, is useful in guiding the initial airway plan. Awake fibreoptic intubation, inhalational induction and direct tracheal access techniques, all in fact have their limitations. No plan is always successful but several back-up plans, good communication within the team, experience, training, adaptability and skill will all help determine the outcome. |