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Laryngeal surgery presents distinct anesthetic challenges due to shared airway access, variable pathology, and the frequent use of carbon dioxide lasers. Laryngeal disease may result from trauma, infection, malignancy, or congenital abnormalities, and patients often have anatomic and physiologic changes related to cancer or prior treatments such as radiation therapy. Preoperative evaluation should include a focused airway assessment and review of comorbidities that may increase perioperative risk, including cardiopulmonary disease and other systemic conditions. Effective anesthetic management centers on maintaining ventilation and oxygenation while optimizing surgical exposure. Ventilation strategies include controlled mechanical ventilation via endotracheal intubation, spontaneous ventilation, subglottic jet ventilation, intermittent apneic techniques, transnasal humidified rapid-insufflation ventilatory exchange, and high-flow nasal cannula oxygen therapy. Selection depends on patient characteristics, underlying pathology, anticipated procedural duration, and the likelihood of difficult intubation. Each technique carries specific risks, including hypoventilation, hypercapnia, barotrauma, or airway fire. Because most procedures involve the use of a carbon dioxide laser, the team must anticipate fire risk and implement preventive measures, including reducing oxygen concentration and using laser-resistant airway devices when indicated. This activity reviews preoperative evaluation strategies, anesthetic management considerations, and common comorbidities associated with laryngeal surgery. Emphasis is placed on airway assessment, ventilation planning, and risk mitigation in the operating room. The activity also underscores the importance of interprofessional collaboration and clear communication among healthcare providers caring for patients undergoing laryngeal procedures throughout preoperative planning, intraoperative management, and emergence. Effective interdisciplinary coordination facilitates timely adaptation to airway challenges and supports safe, high-quality perioperative care. Objectives: Identify anatomic and physiologic changes associated with laryngeal pathology and prior cancer treatment that may complicate airway management.

Because most procedures involve the use of a carbon dioxide laser, the team must anticipate fire risk and implement preventive measures, including reducing oxygen concentration and using laser-resistant airway devices when indicated. This activity reviews preoperative evaluation strategies, anesthetic management considerations, and common comorbidities associated with laryngeal surgery. Emphasis is placed on airway assessment, ventilation planning, and risk mitigation in the operating room. The activity also underscores the importance of interprofessional collaboration and clear communication among healthcare providers caring for patients undergoing laryngeal procedures throughout preoperative planning, intraoperative management, and emergence. Effective interdisciplinary coordination facilitates timely adaptation to airway challenges and supports safe, high-quality perioperative care. Objectives: Identify anatomic and physiologic changes associated with laryngeal pathology and prior cancer treatment that may complicate airway management. Differentiate among available ventilation techniques based on patient characteristics, procedural requirements, and the surgical exposure needs. Implement ventilation and monitoring plans that maintain oxygenation while optimizing surgical conditions. Collaborate with interprofessional healthcare providers to support perioperative airway management strategies to optimize patient care during laryngeal surgery. Access free multiple choice questions on this topic.

Laryngeal pathology may result from trauma, infection, or malignancy, as well as from congenital malformations of the laryngeal structures in children.[1] As laryngeal surgery carries a significant risk of complications, anesthetic management requires careful preoperative planning and close communication with the operating room team. Selection of the ventilation strategy and associated airway management approach depend on patient characteristics, type of laryngeal disease, and the duration of the procedure. This choice is influenced by the need to share the airway with the surgeon, the potential for difficult intubation, and the impact of prior treatment for laryngeal disease. Four primary techniques are used to secure the airway and provide oxygenation to patients undergoing laryngeal surgery: controlled mechanical ventilation, spontaneous ventilation, subglottic jet ventilation, and intermittent apneic anesthesia. Complications can arise from each approach; therefore, interdisciplinary planning and communication are key to facilitating necessary intraoperative adaptations.

Laser ablation and other laryngeal procedures require carefully controlled ventilation, typically using laser-resistant endotracheal tubes or apneic ventilation using various respiratory devices. Close collaboration among the anesthesiologist, anesthetic providers, and otolaryngologist is essential during preparation for laryngeal surgery, as anatomy, tissue friability, and physiology may be altered by cancer or prior radiation therapy to the neck and airway. The intubation and extubation plan, along with the chosen ventilation strategy, should be clearly discussed and communicated to all members of the operating room team. Coordination with the respiratory therapy team is also essential when postoperative ventilatory support is anticipated.

As laryngeal surgery is an aerosol-generating procedure, appropriate use of personal protective equipment (PPE) is essential for infection prevention. A prior study analyzing communication in the pediatric operating room during airway surgery found that enhanced PPE use was associated with detrimental effects on communication among operating room personnel.[21] Although communication aids have been proposed to address this issue, no specific device, speech-to-text application, or software platform has been validated for this purpose.

Effective communication among nursing staff, allied health professionals, and the broader interprofessional healthcare team is essential. Identifying and addressing barriers to communication, including those related to PPE, should occur alongside coordinated planning for airway management and patient positioning to support safe anesthetic care during laryngeal surgery. Clear communication and ongoing assessment of fire risk during the preoperative time-out and throughout the procedure are critical to promote patient safety and optimal surgical outcomes.