Larynx Tumor Poster
1
ANESTHETIC CONSIDERATIONS IN A CASE OF SUPRAGLOTTIC LARYNGEAL TUMOR Author: Dr. LAKSHMIDEEPTHI DAVULURU 1 , Dr. PRABHU 2 . 1-Post Graduate in Anaesthesiology, 2-Associate Professor [JJM MEDICAL COLLEGE,DAVANGERE] RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES INTRODUCTION: Laryngeal cancer is the second most common type of head and neck cancer worldwide 1 . Squamous cell carcinoma is the most common type of supraglottis carcinoma. The supraglottic larynx is partitioned into 4 subdivisions, as follows: aryepiglottic folds, arytenoids, false cords, and epiglottis. Smoking and alcohol are the most common causes of SCC of larynx. Because of its location, the disease and its treatment can affect the function of the larynx, including speech, swallowing, and breathing. Subglottic carcinomas can cause airway compromise at an early stage. . The goal of treatment for supraglottic cancer is cure of disease, with preservation of speech, when possible. Treatment options include surgery, radiation therapy, chemotherapy, or a combination PRE-ANESTHETIC EVALUATION: A 26 yr old male patient presented with change in voice since 1 year. No h/o suggestive of dyspnoea, dysphagia or stridor. O/E patient was moderately built CONCLUSION: Management of airway is crucial in case of supraglottic tumour.One should always anticipate difficult mask ventilation and intubation.muscle relaxants are avoided anticipating difficult intubation. Difficult airway trolly should always be kept ready for these situations. REFERENCES: 1. Chu EA, Young JK. Laryngeal cancer: diagnosis and pre-operative work- up. Otolaryngol Clin N Am. 2008. 41:673- 695. 2. On Indirect Laryngoscopy Examination :A smooth Globular swelling present in situ involving left arytenoid and aryepiglottic fold encroaching towards right arytenoid, vocal cord is not able to visualise clearly. Blood Examination: BT/CT normal, CBC, RFT, LFT are normal.ECG normal. Neck CT scan shows soft tissue density mass in the prevertebral soft tissue plane involving the left aryepiglottic fold and left pyriform recess strongly indicates soft tissue sarcoma. Bilateral upper Jugulo digastric group of enlarged lymph nodes are present. PERI-OPERATIVE MANAGEMENT: Patient was electively posted for DL Scopy and excision biopsy .Monitors were attached.The case was performed under GA. Patient was preoxygenated and premedicated with inj fentanyl, inj glycopyrolate and inj.midazolam.patient was induced with propofol. On laryngoscopy only posterior commisure was visualised, glottis opening was obscured bt tumor mass. Patient was intubated with 6 size cuffed ET tube due to large extension of the tumour . After procedure
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Transcript of Larynx Tumor Poster
ANESTHETIC CONSIDERATIONS IN A CASE OF SUPRAGLOTTIC LARYNGEAL TUMORAuthor: Dr. LAKSHMIDEEPTHI DAVULURU1, Dr. PRABHU2 . 1-Post Graduate in Anaesthesiology, 2-Associate Professor
[JJM MEDICAL COLLEGE,DAVANGERE]RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
INTRODUCTION:
Laryngeal cancer is the second most common type of head and neck cancer worldwide1. Squamous cell carcinoma is the most common type of supraglottis carcinoma. The supraglottic larynx is partitioned into 4 subdivisions, as follows: aryepiglottic folds, arytenoids, false cords, and epiglottis. Smoking and alcohol are the most common causes of SCC of larynx. Because of its location, the disease and its treatment can affect the function of the larynx, including speech, swallowing, and breathing. Subglottic carcinomas can cause airway compromise at an early stage. . The goal of treatment for supraglottic cancer is cure of disease, with preservation of speech, when possible. Treatment options include surgery, radiation therapy, chemotherapy, or a combination PRE-ANESTHETIC EVALUATION:
A 26 yr old male patient presented with change in voice since 1 year. No h/o suggestive of dyspnoea, dysphagia or stridor. O/E patient was moderately built and nourished. No history of any comorbid illnesses. BP 100/70 mm of Hg, PR 80. No pallor, icterus, cyanosis, clubbing or edema. Systemic examination found to be normal. Airway Examination: Mallampatti Grade 2 ,ASA 1,Temporo mandibular Joint movement is normal.
CONCLUSION:
Management of airway is crucial in case of supraglottic tumour.One should always anticipate difficult mask ventilation and intubation.muscle relaxants are avoided anticipating difficult intubation. Difficult airway trolly should always be kept ready for these situations. REFERENCES:
1. Chu EA, Young JK. Laryngeal cancer: diagnosis and pre-operative work-up. Otolaryngol Clin N Am. 2008. 41:673-695.
2.
On Indirect Laryngoscopy Examination :A smooth Globular swelling present in situ involving left arytenoid and aryepiglottic fold encroaching towards right arytenoid, vocal cord is not able to visualise clearly. Blood Examination: BT/CT normal, CBC, RFT, LFT are normal.ECG normal. Neck CT scan shows soft tissue density mass in the prevertebral soft tissue plane involving the left aryepiglottic fold and left pyriform recess strongly indicates soft tissue sarcoma. Bilateral upper Jugulo digastric group of enlarged lymph nodes are present.
PERI-OPERATIVE MANAGEMENT:
Patient was electively posted for DL Scopy and excision biopsy .Monitors were attached.The case was performed under GA. Patient was preoxygenated and premedicated with inj fentanyl, inj glycopyrolate and inj.midazolam.patient was induced with propofol. On laryngoscopy only posterior commisure was visualised, glottis opening was obscured bt tumor mass. Patient was intubated with 6 size cuffed ET tube due to large extension of the tumour . After procedure recovery was smooth and uneventful. Equipment for management of difficult intubation was kept to take care of any complications of the procedure. Patient was monitored & adequate depth of anesthesia was maintained. Procedure was uneventful..
