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Anesthesia for head and neck surgery

Author
Vladimir Nekhendzy, MD
Section Editor
Carin A Hagberg, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

The spectrum of head and neck (H&N) surgery is broad, ranging from simple procedures such as tonsillectomy to precision laryngologic, neurotologic, and image-guided skull-base surgery, complex obstructive sleep apnea (OSA) surgery, sophisticated transoral robotic surgery (TORS), and major H&N cancer surgery with extensive free-flap reconstruction.

This topic will discuss general principles of anesthetic management for H&N surgery, including airway management specific to these cases. Airway evaluation, management of routine and difficult airways for anesthesia, anesthesia for tonsillectomy, anesthesia for thyroid surgery, and anesthesia for craniotomy are discussed more fully separately. (See "Airway management for induction of general anesthesia" and "Rapid sequence induction and intubation (RSII) for anesthesia" and "Management of the difficult airway for general anesthesia" and "Anesthesia for tonsillectomy with or without adenoidectomy in children" and "Anesthesia for craniotomy" and "Anesthesia for patients with thyroid disease" and "Flexible scope intubation for anesthesia".)

PREOPERATIVE EVALUATION

A medical history and anesthesia-directed physical examination should be performed for all patients who undergo anesthesia. In anticipation of head and neck (H&N) surgery, we focus the preoperative evaluation on the airway and on those medical conditions that are associated with complications during these procedures.

Assessment of comorbidities — A number of medical conditions are either more likely or of particular concern for patients who undergo H&N surgery.

For patients with uncontrolled hypertension, cerebrovascular disease, coronary artery disease, chronic renal insufficiency, or advanced liver disease, controlled hypotensive techniques should be avoided, and intraoperative hypotension should be treated aggressively. (See 'Moderate controlled hypotension' below and "Evaluation of cardiac risk prior to noncardiac surgery".)

                                      

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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 26 00:00:00 GMT+00:00 2016.
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