Surgeon-Anesthesiologist Partnership in Shared Airway: TORS, DISE, and Microlaryngoscopy

PROGRAM DESCRIPTION: Transoral Robotic Surgery (TORS), Drug Induced Sleep Endoscopy (DISE), and Micro Direct Laryngoscopy (MDL) represent a specialized subset of otolaryngologic procedures for which a "bread and butter" generic approach to anesthetic management is not optimal. These shared airway procedures are ripe for otolaryngologists and anesthesiologists to collaborate to develop innovative and effective techniques to optimize operating conditions, patient experience, and perioperative quality and safety. The panel will employ an interactive case-based format to share our collective learnings from such collaboration. These scenarios will highlight our methodology for developing synergy between anesthesiologists and otolaryngologists to enhance patient safety and innovation in the OR. The cases will highlight structured communication strategies, the role of specialized teams, protocol implementation, and broader systems-based practice pathways. The scenarios will highlight the considerations with regard to high risk airway from pre-operating planning to discharge. We will share our experience with novel approaches to sedation for drug-induced sleep endoscopy, highlight challenges and alternatives for airway management and oxygenation during direct laryngoscopies, and perioperative team preparation and airway handling in TORS. These include the laryngeal mask airways (LMA) for glottic procedures as well as high-frequency jet ventilation and transnasal hi-flow rapid insufflation ventilator exchange (THRIVE). Protocols for TORS, MDL, and DISE that can be enhance efficiency, reduce risk of unexpected emergencies, and be adapted for local use will be shared allowing otolaryngologists an opportunity to collaborate with anesthesiologists to jointly implement these techniques. In addition, the panel will discuss how the approach to each of the three domains was modified slightly to adapt to the COVID-19 Pandemic.

OUTCOME OBJECTIVE 1: Describe approaches to safe and effective Otolaryngology and Anesthesiology collaboration to manage innovative surgical procedures.

OUTCOME OBJECTIVE 2: Navigate preoperative planning, procedural and anesthetic challenges for patients undergoing DISE, MDL, and TORS.

OUTCOME OBJECTIVE 3: Implement and disseminate safe and effective systems-based protocols for DISE, MDL, and TORS that can be adapted to local needs.

BACKGROUND STATEMENT: ORLs face uncertainty regarding effective and safe anesthesia for these novel but complex procedures with limited interspecialty dialogue. We will share strategies to solve these issues and disseminate what we consider the safest best practice protocols for local adaptation.