Difficult airway management in patients with laryngeal tumor: Case series and systematic review-ZENTIME PUBLISHING CORPORATION LIMITED

Home Perioperative Precision Medicine All issues Issue 2

Difficult airway management in patients with laryngeal tumor: Case series and systematic review

Chenglong Zhu^1,3*, Miao Zhou^1,4*, Yongchu Hu², Wenyun Xu², Zui Zou^1,2

¹School of Anesthesiology, Naval Medical University, Shanghai 200433, China. ²Department of Anesthesiology, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China. ³Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China. ⁴Department of Anesthesiology, the Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University, Nanjing 210009, Jiangsu, China.

*The authors have contributed equally to this work.

Address correspondence to: Zui Zou, School of Anesthesiology, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai 200433, China. Email: zouzui@smmu.edu.cn. Wenyun Xu, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai 200003, China. Email: xuwenyun@ smmu.edu.cn.

Acknowledgement: This study was funded by the National Natural Science Foundation of China (81670072), the Shanghai Municipal Committee of Science and Technology (20XD1434400) and Special Project on Incubation of Civil-Military Integration Achievements of the Naval Medical University (2022-RH10). Declaration of conflict of interest: None.

Ethics approval and consent to participate: Chinese Clinical Trial Registry approved this study (ChiCTR2200060783). All procedures and research activities performed in the study were in accordance with the ethical standards of the institutional research committee. Consent was obtained from a legally authorized representative.

DOI: https://doi.org/10.61189/109678mkmeds

Received November 29, 2023; Accepted January 16, 2024; Published June 30, 2024

Highlights

● SEEK^flex (Safe Easy Endotracheal Kit-flexible) is a modified introducer, which provides a simple and rapid way for intubating patients with laryngeal tumors.

● With its non-invasive and gentle approach, SEEK^flex minimizes patient discomfort, enhancing the overall patient experience.

● Flexible fiberoptic bronchoscope remains the most frequently used tool for managing difficult airways.

Abstract

Airway management in patients with laryngeal tumor presents significant challenges and risks. SEEK^flex (Safe Easy Endotracheal Kit-flexible) is a modified introducer developed by our team for the intubation in severe COVID-19 patients. Here, we present 4 cases where SEEK^fle^x facilitated tracheal intubation in patients with laryngeal tumors underwent surgeries and achieved a definitive airway. A systematic review of MEDLINE, EMBASE, CINAHL, and Web of Science databases was also performed using the keywords such as “laryngeal tumor”, “airway management” and “anesthesia” to identify the reports on airway management techniques for patients with laryngeal tumors. 14 papers involving 17 patients were retrieved. All the cases reported positive patient outcomes, though there were instances of intubation failure after general anesthesia. Despite increased availability of basic airway management techniques and various types of intubation tools, challenges persist, especially in patients with pre-existing severe airway obstruction. SEEK^flex provides a simple and rapid solution for intubating patients with laryngeal tumors, which ensures a clear airway for patient safety.

Keywords: SEEKflex, laryngeal tumor, airway management, anesthesia

Supplementary Material

Supplementary Material: Four videos of tracheal intubation in four cases.

Supplementary Video 1: