Awake Videolaryngoscopy for Intubation in Patients With Laryngeal Cancer: A Case Series

Abstract

Total laryngectomy is the gold standard surgical approach for laryngeal cancer and is generally conducted under general anesthesia. Orotracheal intubation remains a very delicate step in the general anesthesia process. In otolaryngology (ENT) surgery, it remains considered the preferred method of anesthesia for many surgical procedures. A significant challenge in oncological ENT surgery is the difficulty associated with orotracheal intubation, due to a number of reasons that can lead to failure of orotracheal intubation. To mitigate this risk, experts recommend proceeding with orotracheal intubation with the patient awake and breathing spontaneously. In this case series, we report four patients with supraglottic tumors of the larynx who underwent total laryngectomy surgery under general anesthesia, during which they underwent orotracheal intubation while awake and spontaneous breathing, under no sedative drugs of any kind, in order to avoid complications of orotracheal intubation failure and respiratory apnea due to bleeding tumor masses that engaged the supraglottic space.

Keywords: advanced airway management; awake intubation; difficult airway management; orotracheal intubation; total laryngectomy.

Figure 1. Case 1 evaluation of the Mallampati score: visualization of only the base of the uvula (grade 3)

Figure 2. Case 1 CT scan of the neck showed swelling in the right median-paramedian site with homogeneous density, involving the lingual surface of the epiglottis and the root of the tongue. The glottic plane is asymmetrical, with thickening of the posterior and left lateral walls of the larynx in the supraglottic position

CT: computed tomography