Head and Neck Cancer: Difficult Airways

Welcome to the “At Risk” Airway educational module. This learning episode is aimed at all healthcare staff who routinely deal with patients with head and neck cancers.

Here at The Christie, we regularly treat and manage patients who have tumours affecting their head and neck. Unfortunately, as a result of the tumour, or the treatment they receive – many of these patients already have airways that would be considered “difficult” to manage by an anaesthetist or an ENT surgeon in an emergency.

In addition to this, over the course of their treatment, a small proportion of these patients may go on to develop potentially life-threatening airway compromise or obstruction. These patients will require time-critical support from the anaesthetics, critical care and ENT teams to create a definitive airway, such as a tracheostomy.  As we don’t have ENT on site here at the Christie; some of these patients may need transfer to another hospital site. 

For these reasons, it is important that we are able to identify patients with an “At Risk” airway early, and are aware of how to start management. 

To create this learning episode; we have used actors to create a series of videos that are loosely based on clinical events. Each dramatized scenario is accompanied by a debrief video, and some additional learning. 

Learning Outcomes

• Be able to make an initial basic airway assessment of a patient with a potentially difficult airway
• Understand the detrimental tissue effects of cancer pathology and radiotherapy and how this can lead to airway compromise
• Be aware of some of the possible differential causes of airway compromise – other than radiotherapy
• Be able to identify the clinical features of progressively worsening airway compromise
• Identify specific red and amber flags associated with impending airway obstruction
• Be able to prescribe the common early “holding” treatments in patients with impending airway compromise

These scenarios are by no means exhaustive in covering everything you need to know about difficult, or “at risk” air

Key learning:

• Head and Neck Patients are at a high risk of airway obstruction
• Consider doing a basic airway assessment on many of your patients
• Remember to assess patients for Red Flags
• If there is any evidence of impending airway obstruction
  • Start Holding Measures
  • Call for Help Early
    • Critical Care at the Christie
    • ENT at MRI
    • If you’re not sure about a patient – call for help!
  • For more information, there are a number of educational resources that can be accessed:
  • Management of airway obstruction – BJA Education
  • Tracheostomy