Awake or asleep approach to difficult airway during microlaryngeal surgery

Abstract

Introduction: Patients presenting for microlaryngeal surgery frequently have a difficult airway. The chosen approach to this airway depends on the pathology and the patient’s symptoms. The Aim of the study is to determine the safest anesthesiological approach to difficult airway during microlaryngeal surgery. Materials and Methods: A prospective cohort study including 200 patients undergoing microlaryngeal surgery in the Department of Otorhinolaryngology at the University Hospital “Queen Giovanna” - ISUL, Sofia, in the period 2014-2019; Medical University-Sofia. Preoperative examination of the larynx is performed in all patients by Storz 8402 ZX fiber optic laryngoscope with video capability. Results and discussion: In 76% of the patients the tumor mass causing obstruction is localized in the area of the larynx, and in 24% of them the tumor mass is localized in the area of the hypopharynx. In 20% of the patients with 3rd degree of laryngeal obstruction an awake tracheostomy is chosen as a primary approach because of impossible intubation. The same approach is chosen in all of the patients presenting with respiratory failure at rest. In 25% of the patients with tumor mass causing hypopharyngeal obstruction an awake tracheostomy is chosen as a primary approach because of impossible intubation. Conclusion The decision to proceed with an awake or asleep approach to an anticipated difficult airway depends on the degree of laryngeal or hypopharyngeal obstruction and the experience of the anesthesiologist.