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Abstract
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Background and Aims Urgent tracheostomy is needed to treat upper airway obstruction in patients with head and neck cancer. It sometimes constitute an anesthetic challenge, especially for causing obstruction and distortion of the airway’s anatomy. Bilateral intermediate cervical plexus block (BICPB) allows anesthesia of the anterior neck, allowing the performance of superficial neck surgery. This abstract aims to demonstrate the effectiveness and safety of regional anesthesia in patients undergoing urgent tracheostomy.
Methods A 62-yeard-old man, ASA IV, with history of alcohol abuse and basaloid squamous cell carcinoma (cT3N2bM0) presented to the emergency room with stridor and worsening dyspnoea at rest. He was proposed for urgent definitive tracheostomy, in which induction of general anesthesia had a high risk of airway loss, because the mass was causing glottis obstruction with a maximum diameter of approximately 4 mm. We performed an ultrasound-guided BICPB with 4 mL ropivacaine 0,75% in each side. 100 µg of fentanyl, 1 mg midazolam and 15 mg of ketamine were administered for conscious sedation.
Results 10 minutes after BICPB we obtained sensory block in dermatomes C2-C4. After cannulation of trachea, patient was put under general anesthesia, maintained with sevoflurane. The surgery was performed without complications and the postoperative period was uneventful and painless. He was then transferred to the reference hospital in treatment of head and neck cancer after 3 days.
Cross-sections of cervical CT images. A. Supraglottic zone B. Glottic zone
Conclusions BICPB is an effective alternative anesthetic approach for patients undergoing urgent tracheostomy in whom general anesthesia carries a high risk. It provides complete anesthesia and long-lasting analgesia of the anterior cervical region.