Total Laryngectomy Periprocedural Care

Updated: Feb 29, 2016
  • Author: Eelam Aalia Adil, MD, MBA; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Periprocedural Care

Patient Preparation

Anesthesia

Prior to the induction of anesthesia, an airway management plan is coordinated with the anesthesiology team. In patients with bulky, airway obstructing tumors, an awake tracheotomy may need to be performed. In these cases, the tracheotomy should be performed using local anesthesia in the area of the planned laryngostoma. Once general endotracheal anesthesia is induced, the eyes should be taped shut and padded.

Positioning

The patient is laid in the supine position on the operating room table. A shoulder roll is placed to allow for gentle neck extension. The bed is rotated 180°.

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Monitoring & Follow-up

Antibiotics are continued for at least 24 hours following laryngectomy. Routine postoperative care, including vital signs, intake and output monitoring, tracheostomy care, air humidification, and wound care is started for all patients following surgery. Ventilator assistance and bronchodilator therapy should also be considered in patients with co-existent chronic obstructive pulmonary disease (COPD). Labs to assess thyroid function and nutritional status should be ordered, especially in irradiated patients. Tube feeds are initiated once bowel sounds are present. Oral feeds are started after 1 week in nonirradiated patients. Postradiation patients should wait 2-3 weeks before starting oral feeds.

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