Awake Orotracheal Intubation Shown Successful in Four Patients with Laryngeal Cancer

by Linda Kossoff •

CLINICAL QUESTION

How successful is the use of awake videolaryngoscopy intubation in patients receiving surgery for laryngeal cancer?

BOTTOM LINE

Awake videolaryngoscopy intubation is an excellent strategy to adopt in patients with laryngeal cancer, particularly when potentially complicated intubation is expected.

BACKGROUND: Total laryngectomy for patients with laryngeal cancer is usually conducted under general anesthesia. A challenge in this approach concerns orotracheal intubation, as there is a high risk of losing airway control during the induction of general anesthesia. Performing orotracheal intubation with the patient awake and breathing spontaneously can mitigate this risk.

STUDY DESIGN: Case study

SETTING: Azienda Sanitaria Locale [Local Health Unit], Barletta-Andria-Trani, Italy

SYNOPSIS: For their study, researchers reported on four patients who had been diagnosed with a supraglottic laryngeal tumor not amenable to conservative treatment: 1) an 82-year-old male smoker with hypertensive heart disease and chronic obstructive pulmonary disease (COPD); 2) a 70-year-old male heavy smoker with COPD and a history of percutaneous transluminal coronary angioplasty (PTCA); 3) a 79-year-old male heavy smoker with COPD and a history of two PTCAs; and 4) an 83-year-old male heavy smoker with COPD, hypertensive heart disease, and a history of an aortocoronary bypass. All four patients underwent awake orotracheal intubation without sedation or hypnotic drugs, during which the endotracheal tube was gently positioned in a single shot. Following intubation, general anesthesia was given for the remainder of the procedure. A high degree of patient cooperation was noted in all four cases, and there were no intra-operative or post-operative complications. Authors state that patients who are considered candidates for awake tracheal intubation are those at higher risk of adverse events associated with multiple intubation attempts, airway trauma, airway obstruction, bleeding, and heart failure. They stress the importance of monitoring patients’ vitals during anesthetic care.

CITATION: Barbaro S, Carone P, Lanotte L, et al. Awake videolaryngoscopy for intubation in patients with laryngeal cancer: a case series. Cureus. 2024;16:e62993. doi: 10.7759/cureus.62993