Management of Anesthesia in Mandibular Tumors with Difficult Airway

Triade Marthendro; Dino Irawan

doi:10.37899/journallamedihealtico.v5i4.1604

Triade Marthendro Specialist Program in Anesthesiology and Intensive Care, Riau University/Arifin Achmad General Hospital
Dino Irawan Anesthesiology and Intensive Care Department, Riau University/Arifin Achmad General Hospital

DOI: https://doi.org/10.37899/journallamedihealtico.v5i4.1604

Keywords: Mandibulectomy Anesthesia, Difficult Airway Algorithm, Tracheostomy and Airway, Management

Abstract

A 39 year old female patient with a diagnosis of mandibular tumor underwent mandibulectomy and Free Fibular Flap reconstruction. Preoperative evaluation is carried out on patients, namely by carrying out anamnesis, physical examination and supporting examinations to determine the problem and conclude the patient's physical status. The patient's physical status is ASA III. The patient was intubated awake with a video laryngoscope. After that, sedation and muscle relaxants are given. The operation lasted 10 hours with stable hemodynamics. Post-operatively, patients are treated in the ICU, vital signs are observed and post-operative pain is managed. A closed study conducted by the Professional Committee of the American Society of Anesthesiologists (ASA) revealed that the risks and serious complications of anesthesia are most often closely related to airway management problems. Success in dealing with complications depends on early detection of symptoms and corrective action to prevent the situation from getting worse. In this patient, airway management was based on the Difficult Airway Algorithm.

References

Apfelbaum, J. L., Hagberg, C. A., Connis, R. T., Abdelmalak, B. B., Agarkar, M., Dutton, R. P., ... & Tung, A. (2022). 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology, 136(1), 31-81. https://doi.org/10.1097/ALN.0000000000004002

Auyezkhankyzy, D., Izekenova, A., & Kocyigit, B. F. (2024). Emergencies in inflammatory rheumatic diseases. Rheumatology International, 44(9), 1637-1646. https://doi.org/10.1007/s00296-024-05660-y

Bajwa, S. J. S., Kurdi, M., & Stroumpoulis, K. (2020). Difficult airway management in COVID times. Indian Journal of Anaesthesia, 64(Suppl 2), S116-S119.

Bao, Y., Zhan, Y., Li, X., & Qu, S. (2023). Recent Patents on Intervention Auxiliary Device of Tracheal Stent. Recent Patents on Engineering, 17(6), 147-161. https://doi.org/10.2174/1872212117666221213121605

Bedolla, C. N. (2022). Airway Management: Review of Current Devices and Development of a Novel Endotracheal Tube for Emergency Combat Care (Master's thesis, The University of Texas at San Antonio).

Brewster, D. J., Chrimes, N., Do, T. B., Fraser, K., Groombridge, C. J., Higgs, A., ... & Gatward, J. J. (2020). Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust, 212(10), 472-481.

Cascella, M., Bimonte, S., & Di Napoli, R. (2020). Delayed emergence from anesthesia: what we know and how we act. Local and Regional Anesthesia, 195-206.

Chavez, S., Long, B., Koyfman, A., & Liang, S. Y. (2021). Coronavirus Disease (COVID-19): A primer for emergency physicians. The American journal of emergency medicine, 44, 220-229. https://doi.org/10.1016/j.ajem.2020.03.036

Emala Sr, C. W., Tawfik, V. L., Lane-Fall, M. B., Toledo, P., Wong, C. A., Vavilala, M. S., ... & Wood, M. (2023). The Anesthesiology Physician-Scientist Pipeline: Current Status and Recommendations for Future Growth—An Initiative of the Anesthesia Research Council. Anesthesia & Analgesia, 137(4), 728-742.

Gibbins, M., Kelly, F. E., & Cook, T. M. (2020). Airway management equipment and practice: time to optimise institutional, team, and personal preparedness. British Journal of Anaesthesia, 125(3), 221-224.

Hidayati, N., Hadi, F., Suratmi, S., Maghfiroh, I. L., Andarini, E., Setiawan, H., & Sandi, Y. D. L. (2022). Nursing diagnoses in hospitalized patients with COVID-19 in Indonesia. Belitung Nursing Journal, 8(1), 44-52.

Horvath, B., Kloesel, B., Todd, M. M., Cole, D. J., & Prielipp, R. C. (2021). The evolution, current value, and future of the American Society of Anesthesiologists Physical Status Classification System. Anesthesiology, 135(5), 904-919. https://doi.org/10.1097/ALN.0000000000003947

Karunarathna, I., Gunasena, P., De Alvis, K., & Jayawardana, A. (2024). Clinical management of anaphylaxis: Best practices and pitfalls.

Kornas, R. L., Owyang, C. G., Sakles, J. C., Foley, L. J., & Mosier, J. M. (2021). Evaluation and management of the physiologically difficult airway: consensus recommendations from Society for Airway Management. Anesthesia & Analgesia, 132(2), 395-405. https://doi.org/10.1213/ANE.0000000000005233

Kornas, R. L., Owyang, C. G., Sakles, J. C., Foley, L. J., & Mosier, J. M. (2021). Evaluation and management of the physiologically difficult airway: consensus recommendations from Society for Airway Management. Anesthesia & Analgesia, 132(2), 395-405.

Margy, S. (2022). A Review of the Effect of Brain imaging-Short Review. Eurasian Journal of Chemical, Medicinal and Petroleum Research, 1(3), 88-99.

Miller, K. A., Goldman, M. P., & Nagler, J. (2023). Management of the difficult airway. Pediatric Emergency Care, 39(3), 192-200. https://doi.org/10.2174/1872212117666221213121605

Nidadavolu, L. S., Ehrlich, A. L., Sieber, F. E., & Oh, E. S. (2020). Preoperative evaluation of the frail patient. Anesthesia & Analgesia, 130(6), 1493-1503.

Pritchett, M. A., Oberg, C. L., Belanger, A., De Cardenas, J., Cheng, G., Nacheli, G. C., ... & Folch, E. (2020). Society for Advanced Bronchoscopy Consensus Statement and Guidelines for bronchoscopy and airway management amid the COVID-19 pandemic. Journal of thoracic disease, 12(5), 1781. https://doi.org/10.21037/jtd.2020.04.32

Root, C. W., Pirotte, A. P., & DuCanto, J. (2024). Vomit, Blood, and Secretions: Dealing with the Contaminated Airway in Trauma. Current Anesthesiology Reports, 1-7.

Rosenblatt, W. H., & Yanez, N. D. (2022). A decision tree approach to airway management pathways in the 2022 difficult airway algorithm of the American Society of Anesthesiologists. Anesthesia & Analgesia, 134(5), 910-915.

Singh, B., Arora, S., & Sandhu, N. (2023). Emerging trends and insights in acute flaccid myelitis: a comprehensive review of neurologic manifestations. Infectious Diseases, 55(10), 653-663. https://doi.org/10.1080/23744235.2023.2228407

Sneyd, J. R., Gambus, P. L., & Rigby-Jones, A. E. (2021). Current status of perioperative hypnotics, role of benzodiazepines, and the case for remimazolam: a narrative review. British Journal of Anaesthesia, 127(1), 41-55. https://doi.org/10.1016/j.bja.2021.03.028

Søreide, K., Hallet, J., Matthews, J. B., Schnitzbauer, A. A., Line, P. D., Lai, P. B., ... & Lorenzon, L. (2020). Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Journal of British Surgery, 107(10), 1250-1261. https://doi.org/10.1002/bjs.11670

Spears, W., Mian, A., & Greer, D. (2022). Brain death: a clinical overview. Journal of intensive care, 10(1), 16. https://doi.org/10.1186/s40560-022-00609-4

Sproll, C. K., Holtmann, H., Schorn, L. K., Jansen, T. M., Reifenberger, J., Boeck, I., ... & Lommen, J. (2020). Mandible handling in the surgical treatment of oral squamous cell carcinoma: lessons from clinical results after marginal and segmental mandibulectomy. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 129(6), 556-564. https://doi.org/10.1016/j.oooo.2019.11.011

Williams, F. C., Hammer, D. A., Wentland, T. R., & Kim, R. Y. (2021). Immediate teeth in fibulas: expanded clinical applications and surgical technique. Journal of Oral and Maxillofacial Surgery, 79(9), 1944-1953. https://doi.org/10.1016/j.joms.2021.04.005