Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on modern management of frailty

LIVE: Thursday 17th October 2024, 18:00-19:30 (CEST)

Frailty has a significant impact on health and wellbeing, especially in older adults. Join our experts to understand the factors that contribute to the development of frailty and find out how to manage the condition and reduce the risk of disability, dependency, and mortality.
ADVANCED SEARCH
Log in
Top
Current Oncology Reports

16-09-2024 | Airway Management | Review Free for a limited time

The Difficult Airway in Patients with Cancer

Authors: Timothy V. Feldheim, John P. Santiago, Lauren Berkow

Published in: Current Oncology Reports

Login to get access

Abstract

Purpose of Review

The goal of this review is to provide an overview of difficult airway management in the cancer population.

Recent Findings

Difficult airways can be unanticipated; however, several anatomical and physiological features may predict difficult airway management, with several specific for the cancer patient population. New technologies and techniques for airway management, including non-invasive oxygenation, and even the utilization of ECMO, have led to better outcomes and decreased morbidity. Furthermore, the incorporation of multidisciplinary airway teams has helped reduce morbidity associated with predicted and known difficult airways.

Summary

Cancer patients may exhibit or develop anatomic and physiologic features that may predispose them to difficulty with airway management. As our technologies for airway management continue to advance, as well as further commitment to more interdisciplinary collaboration, difficult airway management in the cancer population will continue to become safer.
Literature
1.
2.
3.
Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Robert Greif P, Klock A, Mercier D, Myatra SN, O’Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. American society of anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;2022(136):31–81.CrossRef
4.
Edelman DA, Perkins EJ, Brewster DJ. Difficult airway management algorithms: a directed review. Anaesthesia. 2019;74(9):1175–85.PubMedCrossRef
5.
6.
Siddiqui KM, Hameed F, Ali MA. Diagnostic accuracy of combined Mallampati and Wilson score to predict difficult intubation in obese patients: a descriptive cross-sectional study. Anesthesiol Pain Med. 2022;11(6):e118626.
7.
Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42:487.PubMedCrossRef
8.
Brown CA 3rd. Approach to the difficult airway in adults for emergency medicine and critical care. In: Connor RF, editor. UpToDate. Wolters Kluwer. Accessed 27 Jun 2024.
9.
You-Ten KE, Siddiqui N, Teoh WH, Kristensen MS. Point-of-care ultrasound (POCUS) of the upper airway. Can J Anaesth. 2018;65(4):473–84.PubMedCrossRef
10.
11.
12.
Kornas RL, Owyang CG, Sakles JC, Foley LJ, Mosier JM. Evaluation and management of the physiologically difficult airway: consensus recommendations from society for airway management. Anesth Analg. 2020;132(2):395–405.CrossRef
13.
14.
Ruetzler K, Bustamante S, Schmidt MT, Almonacid-Cardenas F, Duncan A, Bauer A, Turan A, Skubas NJ, Sessler DI, Collaborative VLS Trial Group. Video laryngoscopy vs direct laryngoscopy for endotracheal intubation in the operating room: a cluster randomized clinical trial. JAMA. 2024;331(15):1279–86.PubMedCrossRef
15.
Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev. 2022;4(4):CD011136.PubMed
16.
Malpas G, Hung O, Gilchrist A, Wong C, Kent B, Hirsch GM, et al. The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review. Can J Anesth. 2018;65(6):685–97.PubMedCrossRef
17.
Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM, Society DA. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120(2):323–52.PubMedCrossRef
18.
Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, Hung OR, Kovacs G, Lemay F, Noppens R, Parotto M, Preston R, Sowers N, Sparrow K, Turkstra TP, Wong DT, Jones PM, Canadian Airway Focus Group. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth. 2021;68(9):1405–36. https://​doi.​org/​10.​1007/​s12630-021-02008-z.CrossRefPubMedPubMedCentral
19.
Powers RE, Schwalk AJ. Overview of malignant central airway obstruction. Mediastinum. 2023;1(7):32–42.CrossRef
20.
Iseli TA, Iseli CE, Golden JB, Jones VL, Boudreaux AM, Boyce JR, Weeks DM, Carroll WR. Outcomes of intubation in difficult airways due to head and neck pathology. Ear Nose Throat J. 2012;91(3):E1-5.PubMedCrossRef
21.
22.
23.
24.
25.
26.
Dekhuijzen P, Decramer M. Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J. 1992;5(8):997–1003.PubMedCrossRef
27.
Wandell GM, Merati AL, Meyer TK. Update on tracheostomy and upper airway considerations in the head and neck cancer patient. Surg Clin North Am. 2022;102(2):267–83.PubMedCrossRef
28.
29.
Liu L, Yue H, Li J. Comparison of three tracheal intubation techniques in thyroid tumor patients with a difficult airway: a randomized controlled trial. Med Princ Pract. 2014;23(5):448–52.PubMedPubMedCentralCrossRef
30.
Pang L, Feng YH, Ma HC, Dong S. Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor. Int Surg. 2015;100(4):589–92.PubMedPubMedCentralCrossRef
31.
Sharma I, Dong W, Vu CN, Zheng G. The impact of head and neck radiation on airway management: a retrospective data review. Can J Anaesth. 2022;69(12):1562–4.PubMedCrossRef
32.
33.
34.
Sirohiya P, Kumar V, Garg R, Gupta N. Tracheostomy over Ambu® Aura40™ in cannot intubate situation due to effects of chemoradiation. Indian J Anaesth. 2018;62(4):319–20.PubMedPubMedCentralCrossRef
35.
Truong AT, Truong DT. Postlaryngectomy stoma versus tracheostomy: implications for perioperative airway management. Anesthesiology. 2019;130(6):1034–5.PubMedCrossRef
36.
McGrath BA, Bates L, Atkinson D, Moore JA, National Tracheostomy Safety Project. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. 2012;67(9):1025–4.PubMedCrossRef
37.
Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, Bedwell JR, Das P, Zhu H, Lee Y, Allen J, Peltz A, Chin K, Schiff BA, Randall DM, Swords C, French D, Ward E, Sweeney JM, Warrillow SJ, Arora A, Narula A, McGrath BA, Cameron TS, Roberson DW. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth. 2020;125(1):e104–18.PubMedCrossRef
38.
39.
Metzner J, Posner KL, Lam MS, Domino KB. Closed claims’ analysis. Best Pract Res Clin Anaesthesiol. 2011;25(2):263–76.PubMedCrossRef
40.
Hashimoto K, Omura K, Ichinose J, Matsuura Y, Nakao M, Mun M. A 3-dimensional airway model for tracheobronchial surgery. JTCVS Tech. 2022;21(13):247–9.CrossRef
41.
Ang KS, Green A, Ramaswamy KK, Frerk C. Preoxygenation using the Optiflow™ system. Br J Anaesth. 2017;118(3):463–4.PubMedCrossRef
42.
Guitton C, Ehrmann S, Volteau C, Colin G, Maamar A, Jean-Michel V, Mahe PJ, Landais M, Brule N, Bretonnière C, Zambon O, Vourc’h M. Nasal high-flow preoxygenation for endotracheal intubation in the critically ill patient: a randomized clinical trial. Intensive Care Med. 2019;45(4):447–58.PubMedCrossRef
43.
Maissan I, van Lieshout E, de Jong T, van Vledder M, Houmes RJ, Hartog DD, Stolker RJ. The impact of video laryngoscopy on the first-pass success rate of prehospital endotracheal intubation in The Netherlands: a retrospective observational study. Eur J Trauma Emerg Surg. 2022;48(5):4205–13.PubMedPubMedCentralCrossRef
44.
Lascarrou JB, Boisrame-Helms J, Bailly A, Le Thuaut A, Kamel T, Mercier E, Ricard J-D, Lemiale V, Colin G, Mira JP, Meziani F, Messika J, Dequin PF, Boulain T, Azoulay E, Champigneulle B, Reignier J, for the Clinical Research in Intensive Care and Sepsis (CRICS) Group. Video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients: a randomized clinical trial. JAMA. 2017;317(5):483–93.PubMedCrossRef
45.
Suhre WM, Lang JD Jr, Madtes DK, Abdelmalak BB. Partnership with interventional pulmonologist: an anesthesiologist’s perspective. Otolaryngol Clin North Am. 2019;52(6):1049–63.PubMedCrossRef
46.
Abdelmalak BB, Doyle DJ. Updates and controversies in anesthesia for advanced interventional pulmonology procedures. Curr Opin Anaesthesiol. 2021;34(4):455–63.PubMedCrossRef
47.
Rosenblatt W, Ianus AI, Sukhupragarn W, Fickenscher A, Sasaki C. Preoperative endoscopic airway examination (PEAE) provides superior airway information and may reduce the use of unnecessary awake intubation. Anesth Analg. 2011;112(3):602–7.PubMedCrossRef
48.
49.
50.
Jung J, Park J, Lee M, Chung YH. Apnoeic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange during rigid bronchoscopy: a report of four cases. J Int Med Res. 2022;50(1):3000605211068309.PubMedCrossRef
51.
Ihra GC, Heid A, Pernerstorfer T. Airway stenosis-related increase of pulmonary pressure during high-frequency jet ventilation depends on injector’s position. Anesth Analg. 2009;109:461–5.PubMedCrossRef
52.
Buczkowski PW, Fombon FN, Lin ES, et al. Air entrainment during high-frequency jet ventilation in a model of upper tracheal stenosis. Br J Anaesth. 2007;99:891–7.PubMedCrossRef
53.
54.
Sehgal S, Chance JC, Steliga MA. Thoracic anesthesia and cross field ventilation for tracheobronchial injuries: a challenge for anesthesiologists. Case Rep Anesthesiol. 2014;2014:972762.PubMedPubMedCentral
55.
Abdelmalak BB. The role of extracorporeal membrane oxygenation in the management of the difficult airway. J Cardiothorac Vasc Anesth. 2023;37(12):2660–1.PubMedCrossRef
56.
Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103(1):33–9.PubMedCrossRef
57.
58.
Cooper RM, O’Sullivan E, Popat M, Behringer E, Hagberg CA. Difficult Airway Society guidelines for the management of tracheal extubation. Anaesthesia. 2013;68(2):217.PubMedCrossRef
59.
de Mestral C, Iqbal S, Fong N, LeBlanc J, Fata P, Razek T, Khwaja K. Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients. Can J Surg. 2011;54(3):167–72.PubMedPubMedCentralCrossRef
60.
61.
McGrath BA, Calder N, Laha S, Perks A, Chaudry I, Bates L, Moore JA, Atkinson D. Reduction in harm from tracheostomy-related patient safety incidents following introduction of the National Tracheostomy Safety Project: our experience from two hundred and eighty-seven incidents. Clin Otolaryngol. 2013;38(6):541–5.PubMedCrossRef
62.
63.
64.
65.
66.
Pandian V, Ghazi TU, Marielle Qiaoshu He, Isak E, Saleem A, Semler LR, et al. Multidisciplinary difficult airway team characteristics, airway securement success, and clinical outcomes: a systematic review. Ann Otol Rhinol Laryngol. 2022:000348942211231–000348942211231. https://​doi.​org/​10.​1177/​0003489422112312​4.
Metadata
Title
The Difficult Airway in Patients with Cancer
Authors
Timothy V. Feldheim
John P. Santiago
Lauren Berkow
Publication date
16-09-2024
Publisher
Springer US
Published in
Current Oncology Reports
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-024-01597-4

2024 ESMO Congress

Add-on Ra223 could be a new first-line option in mCRPC

Adding radium-223 to first-line enzalutamide significantly improves the survival of patients with bone metastatic castration-resistant prostate cancer.

Read more

AI model can predict tumor mutations

No OS benefit of adding preoperative CRT in gastric cancer

T-DXd supported for breast cancer with brain metastases

» View more highlights on the ESMO 2024 hub page

SPONSORED

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

  • Webinar | 01-10-2024 | 12:30 (CEST)

In this webinar, Professor Martin Dreyling and an esteemed international panel of CAR T-cell therapy experts discuss the latest data on the safety, efficacy, and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL.

Please note, this webinar is not intended for healthcare professionals based in the US and UK.

Sponsored by:
  • Novartis Pharma AG
Chaired by: Prof. Martin Dreyling
Developed by: Springer Healthcare
Get a reminder for the on-demand version
Image Credits