Challenges in Ventilation during Total Intravenous Anaesthesia in Patients with Laryngectomy Stoma: A Case Report

Abstract

The complete excision of the larynx, which includes the hyoid, epiglottis, and varying segments of the upper trachea, is known as a total laryngectomy. This procedure creates a defect that necessitates pharyngeal correction, as well as the formation of a permanent tracheostomy (tracheostome). Following a total laryngectomy, the trachea is brought to the skin as a stoma, and it is no longer anatomically connected to the digestive tract or oropharyngeal cavity. As a result, bag-mask ventilation, face masks, or nasal cannulas cannot effectively provide oxygen to the lungs. Intubation of the trachea from above the stoma via the oral or nasal route will also be unsuccessful. Hereby, the authors present a unique case of 73-year-old male patient with post-laryngectomy undergoing oesophageal dilation under Total Intravenous Anaesthesia (TIVA). Various challenges encountered while ventilating a patient with a laryngectomy stoma during TIVA has been discussed. Authors also emphasised various methods that can be considered for assisting ventilation in emergency scenarios.

Keywords

• difficult ventilation
• oesophageal dilation
• tracheostoma