Management of airway in patients with laryngeal tumors.
OBJECTIVE
To describe our systematic approach to securing the airway in patients with laryngeal tumors, developed over a 10-year period.


METHODS
Retrospective analysis.


METHODS
University-affiliated veterans administration medical center.


METHODS
Eight hundred one patients presenting for laryngeal tumor surgery in a 10-year period, 285 of whom underwent tracheostomy (25 with local anesthesia and 260 with general anesthesia).


METHODS
Preoperative examination, including history, physical examination, computed axial tomography and/or magnetic resonance imaging, and ear, nose, and throat surgeons' evaluation via indirect laryngoscopy or fiberoptic bronchoscopy were performed before the anesthesiologist's interventions. Local (topical) anesthesia and mild sedation were used for laryngeal evaluation with fiberoptic bronchoscopy. Tumor grade was then established, which determined how the airway would be secured: general anesthesia induction, receive topical anesthesia for awake, direct laryngoscopy, and tracheal intubation, or undergo tracheostomy with local anesthesia.


RESULTS
When the airway was secured, surgeons performed the biopsy, (any) tumor debulking, laser excision, or tracheostomy to establish both the airway and the diagnosis. Pulmonary function, including flow-volume loops and blood gas analysis were also useful in evaluating the degree of obstruction and gas exchange. In the event of respiratory distress, tracheostomy was performed after tracheal intubation or with local anesthesia, followed by direct laryngoscopy and biopsy. Depending on the diagnosis, further surgery and radiation treatment were planned next.


CONCLUSIONS
With these guidelines, we have reduced the frequency of emergencies because of a lost airway, bleeding, or dislodging of tumor.
Moorthy
Sreenivasa S
SS
Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Gupta
Sanjay
S
Laurent
Brynte
B
Weisberger
Edward C
EC
D000287:Administration, Topical; D000402:Airway Obstruction / Q000517:prevention & control*; D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D001706:Biopsy / Q000379:methods; D001999:Bronchoscopy / Q000379:methods; D005336:Fiber Optic Technology / Q000379:methods; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014139:Tracheostomy / Q000379:methods*