ANESTHETIC CONSIDERATIONS IN A CASE OF SUPRAGLOTTIC LARYNGEAL TUMOR

Author: 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 ofhead 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.

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:

CONCLUSION:

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.

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 preoperative work-up. Otolaryngol Clin N Am. 2008. 41:673695.
2.