Application of cervical epidural anesthesia in patients with head and neck carcinoma

In head and neck carcinoma surgery, we often encounter patients for whom there is high risk in operations under general anesthesia (GA) with artificial ventilation management, such as elderly patients or those with comorbidities or impaired organ function. Three patients with head and neck carcinoma for whom risks were high under general anesthesia underwent surgery under cervical epidural anesthesia (CEA). The first case is 67-year-old male with cT2N3M0 laryngeal carcinoma. The patient had several medical history such as angina pectoris, renal impairment developed following cisplatin administration and combined ventilator impairment. Right neck dissection was performed (Level I–IV) under CEA. A decrease in blood pressure was observed during surgery, but was controlled with a small dose of vasopressor and fluid replenishment. The second case is 83-year-old female with cT4aN0M0 submandibular gland carcinoma. She had a history of chronic thoracic empyema and severe respiratory dysfunction was observed. Right submandibular gland carcinoma resection and neck dissection (Level I) were performed under CEA. As respiratory depression occurred following anesthesia induction, tracheotomy was performed and artificial ventilation management was still required after surgery had been completed. The third case is 87-year-old male with rT2N0M0 laryngeal carcinoma. Total laryngectomy was performed under CEA. In Case 2, other than the respiratory problems, no other complications were observed during or after surgery. Operation time and amount of hemorrhage were again comparable to those for surgery under GA. For patients at high risk under GA or with systemic diseases or impaired organ function, CEA represents a therapeutic option.