Laryngectomy Perioperative Patients presenting for a laryngectomy will have a degree of airway compromise and this will influence the method of induction.

Once the airway is secured, ensure that the endotracheal tube is directed away from the surgical field. A nasogastric tube may need to be inserted for postoperative feeding. Due to the risk of intraoperative bleeding, it is important to consider what would be appropriate monitoring. Invasive arterial blood pressure is useful. If you consider using a central venous line, it will need to be placed in the antecubital fossa or in the femoral vein.

The patient should be positioned head up with pressure points padded. There is a potential for heat loss, so it is appropriate that a warming blanket and fluid warmer are used.

Intraoperative hypotension may be required to decrease blood loss and help facilitate surgery. Vigilance is required during the operation due to the risk of an air embolism or a pneumothorax.

The upper portion of the trachea is eventually brought out at the front of the neck as a stoma.

Confusingly, often a tracheostomy tube is placed into the new laryngectomy end stoma. When the neck is dressed, it can look just like a tracheostomy, so remember the bedhead sign and clear handovers. The tube helps to stabilise the new stoma and protect it from suction.

Patients may also have a tracheo-oesophageal puncture created during primary surgery. We'll explain about this later.

Patients will need careful recovery and immediate post-op care in a dedicated head and neck unit (or high dependency unit) with knowledgeable staff.