Preliminary construction and application of the AFSP risk stratification framework for anesthetic management in airway tumors: a case report

To initially construct the Anatomy-Function-Surgery-Patient (AFSP) four-dimensional risk stratification framework, establish a dynamic anesthetic decision-making framework based on this framework, explore its application value in the anesthetic management of patients with airway neoplasms. This is a retrospective analysis of a single patient’s multistage treatment course. The AFSP scoring tool was constructed based on relevant clinical guidelines and literature. A retrospective case of a 77-year-old patient with complex tracheal neoplasms was selected. The AFSP framework was applied to dynamically evaluate perioperative risks in three sequential treatment phases (tumor ablation combined with stent implantation, stent removal, and granulation tissue resection), guide the adjustment of anesthetic strategies, and observe the clinical outcomes. During Stage I (tumor ablation + stent implantation), the patient’s AFSP score reached 11 points, categorized as Grade IV (extremely high risk). We adopted general anesthesia supported by extracorporeal membrane oxygenation (ECMO), which effectively prevented the life-threatening cannot intubate cannot oxygenate (CICO) crisis during anesthetic induction. In Stage II (stent removal), the AFSP score decreased to 8 points, falling into Grade III (high risk). The anesthetic strategy was adjusted to rapid sequence induction combined with high‑frequency jet ventilation (HFJV), which precisely targeted key risks including stent adhesion and intraoperative bleeding. For Stage III (granulation tissue resection), the AFSP score remained at 9 points (Grade III, high risk). On the basis of continuing the ventilation strategy used in Stage II, we added preoperative psychological intervention. No severe anesthesia-related complications occurred throughout the three treatment phases, and the patient completed the entire therapeutic course successfully, suggesting the application value of the AFSP framework in the anesthetic management of airway neoplasms. The initially constructed AFSP four-dimensional risk stratification framework may facilitate the evaluation of perioperative risks in patients with airway neoplasms and help guide individualized anesthetic management strategies for those undergoing multistage treatment, potentially improving perioperative safety. This study is based on a single patient with a limited sample size; the universality of the conclusions needs to be further verified in larger cohorts, and the AFSP scoring tool requires optimization with more clinical data.