Head and neck cancer recurrence with limited mouth opening, radiation fibrosis and confirmed COVID-19 infection: approach to airway management

Authors

  • Faisal Shamim Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan https://orcid.org/0000-0001-5504-8341
  • Muhammad Sohaib Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
  • Kashaf Shahid Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
  • Syed Akbar Abbas Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

DOI:

https://doi.org/10.47391/JPMA.5588

Abstract

We present a case that describes the airway management of a patient with recurrent head and neck cancer and confirmed COVID-19 infection. Securing airway of these patients with anticipated difficulty and at the same time limiting virus exposure to providers can be challenging. The risk of aerosolization during awake tracheal intubation is extreme as it carries a high risk of transmitting respiratory infections. A multidisciplinary team discussion before the procedure highlighted aspects of both airway management and the urgency of surgical procedure where particular care and modifications are required. Successful flexible bronchoscopy and intubation was done under inhalational anaesthetics with spontaneous breathing. Although fiberoptic intubation during sleep,in anticipated difficult airways, have led to enhanced intubation time, this technique was opted to minimize the risk of aerosol generation associated with topicalisation, coughing and hence reduced incidence of cross infection to health care workers.

Author Biographies

Faisal Shamim, Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan

Department of Anaesthesiology

Associate Professor

Muhammad Sohaib, Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan

Department of Anaesthesiology

Assistant Professor

Kashaf Shahid, Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan

Department of Anaesthesiology

Resident

Syed Akbar Abbas, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

Department of Surgery

Assistant Professor

Published

2023-03-15

How to Cite

Shamim, F., Sohaib, M., Shahid, K., & Abbas, S. A. (2023). Head and neck cancer recurrence with limited mouth opening, radiation fibrosis and confirmed COVID-19 infection: approach to airway management. Journal of the Pakistan Medical Association, 73(4), 912–914. https://doi.org/10.47391/JPMA.5588

Issue

Section

CASE REPORT