Minitracheostomy in elective surgery of the larynx: an alternative to formal tracheostomy

Management of airway in patients with laryngeal tumors

STUDY OBJECTIVE

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

DESIGN

Retrospective analysis.

SETTING

University-affiliated veterans administration medical center.

PATIENTS

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).

INTERVENTIONS

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.

MEASUREMENTS AND MAIN 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.

Management of upper airway obstruction using a Seldinger minitracheotomy kit

Two adult patients with upper airway obstruction due to epiglottitis and infectious mononucleosis requiring urgent airway management are presented. Successful establishment of an open airway was achieved by performing a minitracheotomy using the Seldinger technique followed finally with nasotracheal fibreoptic intubation.