
Managing a difficult airway is a critical aspect of patient care, particularly in individuals with cancer, whose unique anatomical and physiological features can pose challenges for ventilation and intubation. Current Oncology Reports recently published a review by UF Department of Anesthesiology colleagues Timothy Feldheim, M.D., John Santiago, M.D., and Lauren Berkow, M.D., titled “The Difficult Airway in Patients with Cancer,” that provides an overview of the techniques and improvements made in treating this patient population.
While difficult airways can be unanticipated, specific conditions in cancer patients—such as tumor growth, anatomical changes from surgery, or effects from radiation and chemotherapy—can increase the likelihood of complications. These factors make airway management in patients with cancer particularly complex and require specialized approaches tailored to their needs.
Recent advancements in airway management techniques, including noninvasive oxygenation methods and the introduction of extracorporeal membrane oxygenation (ECMO), have improved patient outcomes and reduced morbidity in high-risk cases. These innovations allow for more precise control over oxygenation and ventilation, ensuring better safety and more favorable outcomes during airway management procedures.
The review details considerations for difficult airways in patients with cancer, including surgical airway considerations and airway management strategies, and notes specific issues related to head and neck cancer patients. It further examines extubation complications and considerations for patients with Do Not Resuscitate or Do Not Intubate orders.
In addition, the authors review how the establishment of multidisciplinary airway teams has been a game-changer in managing difficult airways in cancer care. These teams typically consist of anesthesiologists, ENT and oral maxillofacial surgeons, and other specialists working together to develop a comprehensive plan for airway management. This collaborative approach has been shown to significantly decrease complications associated with difficult airways by allowing for more tailored interventions and proactive management strategies.
“A multidisciplinary approach among the oncology, surgical, and anesthesia teams is important to identify challenges and plan for safe airway management,” the authors note. “Advances in technology such as video laryngoscopy and high flow oxygenation have decreased morbidity and mortality related to airway management and may be especially useful in the cancer patient population.”
As airway management technologies continue to evolve, and interdisciplinary collaboration becomes more widespread, the safety of managing difficult airways in cancer patients will only improve. With these advancements, medical professionals are better equipped to address the unique challenges posed by cancer-related airway issues, ensuring that patients receive the best possible care during high-risk procedures.
Congratulations to Drs. Feldheim, Santiago, and Berkow!