Airway Safety of Patients Undergoing Head and Neck Surgery : A Multimodal Approach

Abstract

  Well-known algorithms of airway management produced by Japanese and foreign medical societies might not be easily applicable to patients undergoing head and neck surgery. Blind insertion of supraglottic airways, as recommended in the Yellow Zone of the JSA algorithm, can cause bleeding or rupture cystic lesions near the pharynx or larynx. Establishing a surgical airway via the front of the neck, which is a last resort in a CICV situation, can be difficult or even impossible in patients with a distorted anatomy arising from scar tissue resulting from a previous surgery or radiation treatment. Therefore, the airway management plan must be individualised depending on the patient’s airway anatomy as well as co-existing diseases. An appropriate choice of airway device does not necessarily ensure a successful intubation. Physiological measures to prolong the duration of safe apnoea should be utilised. The effectiveness of peri-oxygenation using high-flow nasal oxygen is now being recognised. Opportunities to perform awake tracheal intubation may be decreasing, and this technique may become obsolete. However, it might also be the only option to secure an airway under dire circumstances, such as an impending obstruction. Short-acting or rapidly reversible intravenous sedatives and opioids are useful. However, even when the drug effect wears off, upper airway patency can be lost if rapid swelling of the throat occurs. Although not fully appreciated, extubation following head and neck surgery is the most precarious phase. Adequate communication among the anaesthesia, surgical, and nursing staff members is extremely important during this critical period. Learning from the aviation industry, a so-called High Reliability Organisation, could help to improve the safety of perioperative care. A “Sterile Cockpit” approach and the phrase “Below Ten (thousand)” can be readily applied in daily practice.