Navigating Complex Airway Challenges in Advanced Laryngeal Cancer: A Case of Total Laryngectomy with Multidisciplinary Anaesthetic Care

Laryngeal Squamous Cell Carcinoma (SCC) is a head and neck cancer that usually causes airway compromise at advanced stages, with substantial anaesthetic implications for its surgical management. The author, here presents a case of a 57-year-old man with worsening hoarseness, dysphagia, and exertional dyspnoea, diagnosed with well-differentiated laryngeal SCC. The preoperative evaluation identified predictors of a difficult airway, such as limited mouth opening and limited neck extension. The anaesthetic management focused on preserving spontaneous ventilation, securing the airway, and ensuring safe positioning. Intravenous ketamine and dexmedetomidine were used to provide sedation, and continuous oxygenation was maintained with a high-flow nasal cannula using the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) technique. Fibreoptic intubation was performed. After confirming tracheal placement, neuromuscular blockade was administered, and anaesthesia was maintained with sevoflurane. The nasal endotracheal tube was replaced with a flexometallic tube through a tracheostomy stoma under surgical control, with uninterrupted ventilation. The patient underwent a total laryngectomy with tracheostomy and had an uneventful recovery. The case illustrates the importance of a personalised approach to airway management, advanced oxygenation techniques, and multidisciplinary coordination in the anaesthetic management of complex laryngeal cancer surgery.