Anaesthetic implications for brachytherapy for head and neck cancer patients: A retrospective analysis

To study the problems associated with the anaesthetic management of patients with head and neck cancers requiring brachytherapy, the hospital records of 87 patients were analysed retrospectively. There was a high incidence of associated systemic diseases (26.4%), altered nutritional and metabolic status (8.4%) and predisposition for difficult intubation (24%) in these patients, with a history of prior external beam irradiation therapy (28.7%) or chemotherapy (20.7%). Difficult intubation was recorded in 10.34% patients and prior external beam therapy emerged as one of the most important associated factors. Elective tracheostomy - which was performed in 21.8% of our patients - should be considered in any patient with cancer of the base of tongue, tonsil or pyriform fossa. The advantages of using balanced anaesthesia (93% patients in this study) include a greater haemodynamic stability, ease of insertion of plastic tubings for brachytherapy and safer post operative recovery. These patients remain at a higher risk for post operative airway edema and aspiration and special care should be continued in the post anaesthesia care unit till airway reflexes are fully competent.