SAFETY OF DIAGNOSTIC EVALUATION UNDER ANAESTHESIA WITHOUT ENDOTRACHEAL INTUBATION FOR HEAD NECK SQUAMOUS CELL CARCINOMA PATIENTS- WHEN SHOULD WE AVOID
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Airway management is a very important aspect during head and neck squamous cancer (HNSCC) diagnostic procedures under anaesthesia, as the upper airway is shared by the anaesthesiologist as well as the surgeon. Adequate airway management is essential during these procedures due to safety issues and cost effectiveness and also to prevent an airway emergency. There is always a question of which patients need endotracheal intubation and in whom we should avoid. We wanted to assess the
... ed to assess the merits and demerits of upper airway diagnostic procedures in HNSCC under general anaesthesia with or without endotracheal intubation and determine the factors which may lead to an airway emergency or endotracheal intubation. METHODS This is a retrospective observational study of consecutive HNSCC patients, who underwent diagnostic or therapeutic rigid laryngoscopy under anaesthesia between Dec 2015 till Jul 2017 (retrospective) and Aug 2017 till December 2018 (prospectively maintained database) at a tertiary referral centre. Consecutive patients of HNSCC who underwent diagnostic endoscopy under anaesthesia for biopsy or mapping of the disease were included in the study. 393 patients' data was screened, out of which 303 patients were eligible for our study. 90 patients were excluded from the study, 30 were in stridor and 60 had a prior tracheostomy at the time of diagnostic evaluation. Various factors were evaluated for endotracheal intubation. RESULTS 303 consecutive patients' database was analysed. Male:Female ratio was 93:210 (1:2.3); age ranged from 27 years to 81 years; mean age was 43 years; body mass index ranged from 17-33 with median 20. The site of lesion (glottis) and prior treatment were found to be significant factors for elective intubation. Micro-laryngoscopic procedure was found to be significant for endotracheal intubation. Rest all procedures can be safely performed with total intravenous anaesthesia (TIVA). CONCLUSIONS Direct laryngoscopy with or without biopsy for UADT SCC is safe without intubation baring few cases. We can do a DL Scopy next day of visit to our centre in per primum, thereby reducing the waiting period and establishing diagnosis early and hence reducing overall treatment time. it is cost effective. Patients with prior cancer directed treatment need intubation because of altered anatomy and neck tissue fibrosis. ML scopy takes longer time; hence, apnoea technique is not recommended due to CO2 retention; intermittent intubation through the laryngoscope is acceptable.