Airway management in patients with surgical treatment of oral cavity carcinoma.

BACKGROUND

Local tumor-related anatomical changes can complicate the anesthetic airway management of patients with carcinoma of the oral cavity. The aim of this study was to investigate whether there are predictive factors for the occurrence of a difficult airway in this patient cohort and whether a difficult airway influences postoperative outcome. In addition, the influence of an intraoperative tracheostomy on postoperative outcome was to be analyzed.

METHODS

The treatment records of 201 patients with oral cavity carcinoma who underwent surgery between 2012 and 2023 in a single center were retrospectively analyzed. The definition of difficult airway corresponded to the current S1 guideline of the German Society of Anesthesiology and Intensive Care Medicine from 2015. An association between possible predictive factors and a difficult airway was investigated. The influence of BMI, Mallampati score and Cormack/Lehane score on the number of intubation attempts was analyzed separately. Furthermore, the influence of a difficult airway on the duration of intubation and the duration of the postoperative inpatient stay as well as the postoperative ICU stay was investigated. In addition, the association between an intraoperative tracheostomy and the duration of intubation as well as the duration of the postoperative inpatient stay was analyzed.

RESULTS

Difficult airway occurred in 15 patients (7,5%) and 136 (68%) underwent intraoperative tracheostomy. An indirect laryngoscopy was used in advance in 32,8% of the total patients and 45,4% of the patients undergoing revision surgery. Among the investigated variables, no predictive factors for a difficult airway could be identified. Regarding the number of intubation attempts required, a higher BMI and Mallampati score did not lead to increased number of intubation attempts; however, patients with a Cormack/Lehane score of 3 were significantly more likely to require 2 attempts than patients with a score of 1 or 2 (p = 0.0225). The success rate of first intubation attempt was 78% with videolaryngoscopy, compared to 95,5% when direct laryngoscopy was used (p = 0,0008). A difficult airway did not lead to prolonged postoperative ICU stay and total hospitalisation length. Patients with an intraoperative tracheostomy had a significantly longer mechanical ventilation and total hospitalisation length than patients without (p < 0.0001).

CONCLUSION

Within the limitations of this study, no patient-specific predictors for a difficult airway were identified in patients with oral cavity carcinoma. Videolaryngoscopy in advance did not increase the success rate of the first intubation attempt compared to direct laryngoscopy. Despite this, videolaryngoscopy may be a preferable approach in this population, especially in patients undergoing revision surgeries. The results highlight the importance of a careful preoperative assessment with clearly defined criteria for a difficult airway and appropriate anaesthesiological preparation to avoid complications during intubation.

TRIAL REGISTRATION

Ethics committee of the University of Ulm, approval reference: 115/23, approval date: 08.05.2023.