Surgery on the head and neck requires excellent communication between surgeon and anaesthetist for a successful and safe outcome. The shared and often complex airway means that the anaesthetist and surgeon are integral in facilitating the work of each other and require a clear understanding of the needs of the other. Airway difficulties can mean that speed is of the essence and both parties need to work quickly together to obtain a safe airway.

Pre-operative assessment

The age range covered in routine otolaryngology and maxillofacial surgery spans from cradle to grave and covers a wide variety of pathology. Those patients who are generally fit and well with no significant cardiovascular or respiratory pathology require no more than standard pre-operative assessment appropriate for the age of the patient and nature of the surgery. Many cases are suitable for treatment as a day case. There are some notable exceptions where a more detailed pre-assessment is required.

Head and neck malignancy

A significant number of upper aerodigestive tract malignancies are associated with a prolonged history of smoking. The cardiovascular and pulmonary effects of this exposure need to be ascertained to establish any potential pre-operative optimisation or contraindications to surgery.