Consensus Statement

The SHANA Education Board notes that increased complexity of head and neck anesthesia cases, as well as an expanding patient population that was previously considered unsuitable or unfit for surgery, have created new unique challenges for the anesthesiologist. State of the art head and neck anesthesia requires the anesthesiologist to be adept with various methods of managing the difficult airway and performing airway exchange, to competently execute different intraoperative ventilation strategies, to be proficient with both inhalational and total intravenous anesthesia, and be able to quickly tailor anesthetic techniques to the variable duration of the surgical cases.

Successful anesthetic management of head and neck cases requires a high degree of cooperation with the surgeon, a reciprocal understanding of the potential problems, and adequate preparation on both sides to meet the anticipated challenges that may arise. Thorough appreciation by the anesthesiologist of the complexity of the upper airway anatomy, the pathological process involved, and familiarity with all steps of the surgical procedure are necessary for devising a rationale anesthetic plan, and maintaining good communication and working relationship with the surgeon. The expert ability to safely share the patient’s airway with the surgeon, and an intimate knowledge of possible immediate intraoperative and early postoperative complications, greatly contribute to safe patient management in the perioperative period.

Based on the combined individual and multi-institution experience, the Education Board highly recommends a creation of a division of head and neck anesthesia in the institutions with sufficient surgical volume of head and neck cases.

The Education Board further agrees that it is highly desirable to combine dedicated head and neck anesthesia training of the trainees with structured difficult airway training. Nearly 40% of all anesthesia airway cases reported to NAP4 were associated with upper airway malignancy or disease processes of the head and neck. The trainees will have unique opportunity to learn advanced airway management in clinical setting, in the patient population with the high incidence of difficult airways. The Education Board emphasizes that elective teaching of advanced airway management devices and techniques requires proper patient selection, a non-hurried teaching environment, good clinical judgment, expert faculty, and direct supervision by the attending anesthesiologist.

The Education Board recognizes that particular challenges exist in developing the field of pediatric head and neck anesthesia.

The Education Board will focus its immediate efforts at improving clinical education and patient care by establishing quality educational objectives and goals, by identifying the essential knowledge and skill sets required for best head and neck anesthesia practice, and by introducing structured, curriculum-based teaching.