Airway emergencies in patients with laryngectomy and tracheostomy

Patients with a tracheostomy or total laryngectomy are a distinct and high-risk population for perioperative airway emergencies. This review examines the recognition and management of acute airway emergencies in these patients, with emphasis on intraoperative hazards, equipment selection, and complications unique to the surgically altered airway.

The anatomical distinction between a tracheostomy and a total laryngectomy stoma remains widely underappreciated, with national registry data reporting a 26% mortality rate when oral intubation is attempted in laryngectomy patients. Common emergencies such as tube obstruction, accidental decannulation, and hemorrhage can be fatal. Intraoperative hazards including endobronchial tube migration, circuit disconnection, and inadvertent cannulation of a tracheoesophageal puncture tract represent an underrecognized category of harm. Structured algorithms, simulation-based training, and multidisciplinary quality improvement programs demonstrate measurable reductions in adverse events.

Patients with neck stomas are at risk for life-threatening airway compromise requiring prompt identification of airway anatomy and appropriate equipment. Clinicians must be prepared for complications like tube obstruction, tube migration, circuit instability, and bleeding. Preventing harm requires the use of cognitive aids, structured protocols, simulation-based training, and ongoing quality improvement programs.