Anaesthesia for patients with a laryngectomy should proceed as per any other anaesthetic, following pre-op assessment and preparation. Whilst there are significant differences with the airway, a laryngectomy stoma makes airway management extremely straightforward.

There have been errors in recognising that a patient is a neck-only breather, particularly if the patient is managed outside of a head and neck surgical setting (general theatres for example). It is important that all staff from theatre reception, through theatres and recovery and then back to the ward, are aware of the laryngectomy.

Question: Can you think how you would manage a laryngectomee's airway?

Answer

Anaesthesia for patients with a laryngectomy should proceed as per any other anaesthetic, following pre-op assessment and preparation. Whilst there are significant differences with the airway, a laryngectomy stoma makes airway management extremely straightforward.

There have been errors in recognising that a patient is a neck-only breather, particularly if the patient is managed outside of a head and neck surgical setting (general theatres for example). It is important that all staff from theatre reception, through theatres and recovery and then back to the ward, are aware of the laryngectomy.

Question: Can you think how you would manage a laryngectomee's airway?

Answer: Talk to the patient about any coverings, base plates or valves that they usually use for humidification and vocalisation. Tracheo-oesophageal puncture (TEP, Fig 1) valves do not need to be removed prior to anaesthesia. Removing a TEP valve can damage the tissues and risk the patient's future speech. We will review TEP valves later in this session. Involve ENT medical or specialist nursing teams if you are not sure.

Spontaneous breathing or 'mask' anaesthetics are possible for short procedures. The risk of aspiration is virtually eliminated as the airway and oesophagus are entirely separate. Due to the anatomy, it might be difficult to get a good fit with a paediatric facemask or supraglottic airway device.