Difficult Tracheal Intubation and Airway Outcomes after Radiation for Nasopharyngeal Carcinoma

Abstract

ObjectiveThe aim of the study was to characterize the incidence and management of difficult tracheal intubations (DTIs) in nasopharyngeal carcinoma (NPC) after primary radiation therapy (RT).MethodsThe study was a retrospective review of airway assessment and outcomes in post‐RT NPC patients. Primary analysis was performed on patients who underwent post‐RT procedures, who were split into non‐DTI and DTI groups. Patients were classified as DTI if they (i) required >1 attempt to intubate, (ii) failed to be intubated, or (iii) experienced complications attributed to airway management. Secondary analysis was performed between patients who underwent post‐RT procedures (procedure group) and those who did not (control group).ResultsOne‐hundred and fifty patients were included, and 71.3% underwent post‐RT procedures, with no differences in characteristics between the procedure and control groups. One‐hundred and fifty procedures were identified, and 28.0% were categorized as DTI. There was no difference in patient characteristics or airway assessment measures between DTI and non‐DTI groups. Regression analysis revealed concurrent cervical mobility restriction, and trismus increased DTI incidence by 7.1‐fold (p = 0.011). Being non‐White was an independent predictor of DTI. The incidence of high‐grade intraoperative laryngoscopic view was lower in the non‐DTI compared to the DTI group (20.4% vs. 64.3%, p < 0.0001). Failure to intubate occurred in 2.0% of cases, and 6.0% cases had perioperative complications. Based on preoperative assessment, sensitivity of predicting DTI was 54.8% and specificity was 63.9%.ConclusionNPC patients frequently undergo post‐RT procedures requiring complex airway management. Rates of DTI and failed intubation are significantly higher than those in the general surgical population, and the ability to predict DTI with standard preoperative airway measures is poor.Level of Evidence4 Laryngoscope, 134:120–126, 2024