Anesthetic management of the patient undergoing head and neck cancer surgery

The head and neck cancer patient should be in the best possible medical condition before facing surgery, bearing in mind the status of the tumor and the urgency of the procedure. Careful assessment of the patient's upper airway will enable the anesthesiologist to select an appropriate course of action to secure the airway before the operation begins. In many cases, the patient can be safely intubated after the induction of general anesthesia. In other situations, the patient may require an examination of the airway while awake with the aid of sedation and topical analgesia to determine the safest intubation technique. If the patient has evidence of a difficult airway, a flexible fiberoptic-guided intubation may be indicated to secure the airway in the awake patient patient before general anesthesia is induced. Some patients with severe airway obstruction or large, bulky supraglottic tumors usually undergo an initial tracheostomy with local anesthesia to secure the airway. Following surgery, extubation of the patient's trachea requires careful attention and may have to be performed over a jet-ventilating stylet.