Chapter 26 - Ear, Nose and Throat Surgery: Airway Management

Summary

Patients undergoing ear nose and throat (ENT, otorhinolaryngeal) surgery probably present more airway management challenges than any other branch of surgery. ENT procedures encompass a range of operations varying in duration, severity and complexity from simple short cases such as myringotomy, through to complex resection and reconstructive surgeries for head and neck cancer. In all cases the surgical team operates close to the airway and in many within the airway, which is therefore shared with the anaesthetist. In this chapter, the authors discuss in some depth these challenges and how to address them, airway management and ventilation options and strategies including but not limited to awake intubation, different subtypes of jet ventilation, and high flow nasal oxygenation as well recent advances in the field. They further discuss extubation strategies and controversies as well as a plan to manage commonly encountered complications such as bleeding in the airway. For a successful outcome, these ‘shared airway’ procedures require close communication and cooperation between anaesthetist and surgeon, an understanding of each other’s challenges, knowledge of specialist equipment, and a thorough preoperative evaluation to identify potential risk factors for poor perioperative outcomes.