Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations
Eoin F. Cleere, Christopher Read, Sarah Prunty, Edel Duggan, James O’Rourke, Michael G. Moore, Pedro Augusto Molina Vasquez, Orla Young, Thavakumar Subramaniam, Liam Skinner, Tom Moran, Fergal O’Duffy, Anthony Hennessy, Andrew Dias, Patrick Sheahan, Conall Fitzgerald, John Kinsella, Paul Lennon, Conrad Timon, Robbie Woods, Neville Shine, Gerard F. Curley, James P. O’Neill
Abstract
Major head and neck surgery poses a threat to perioperative airway patency. Adverse airway events are associated with significant morbidity, potentially leading to hypoxic brain injury and even death. Following a review of the literature, recommendations regarding airway management in head and neck surgery were developed with multicenter, multidisciplinary agreement among all Irish head and neck units. Immediate extubation is appropriate in many cases where there is a low risk of adverse airway events. Where a prolonged definitive airway is required, elective tracheostomy provides increased airway security postoperatively while delayed extubation may be appropriate in select cases to reduce postoperative morbidity. Local institutional protocols should be developed to care for a tracheostomy once inserted. We provide guidance on decision making surrounding airway management at time of head and neck surgery. All decisions should be agreed between the operating, anesthetic, and critical care teams.