Chapter 15 - Anesthesia for neck dissection and laryngectomy

Summary

The terms neck dissection and laryngectomy describe a wide variety of surgical procedures that attempt to remove a cancer and its main route of spread. Neck dissection is commonly performed during laryngectomy for cancer to prevent and treat any local spread of the primary disease. A careful airway evaluation is an essential part of preparation for a patient undergoing laryngectomy with neck dissection. The treatment of laryngeal cancer has three primary goals: tumor removal, prevention of spread and recurrence, and preservation of organ function (phonation and swallowing) where possible. Neck radiation changes can make airway management difficult as its presence is an independent predictor of failure for both bag-mask ventilation and GlideScope intubation. Systolic blood pressure variation of the arterial line tracing can help guide fluid replacement. Alternatively a central line, at a different location from the neck dissection, can be used.