Anesthesia management in deep neck infections; 10 years of experience

Deep neck infections (DNI) are a fatal group of disease with serious complications when they are late in diagnosis and appropriate treatment1. Low socio-economic status, diabetes mellitus, diseases that weaken the immune system can be considered as predisposing factor for DNI2. In the ethiology of DNI, the most causes are infections of teeth and salivary gland in elderly, while infections caused by tooth and parotid gland in young people take the first place3. In the treatment of DNI, oral or IV antibiotics, abscess aspiration with needle, surgical drainage and multidisciplinary close observation have an important place4–6. Especially in delayed DNI patients, both anesthesia induction for surgical drainage purposes and the maintenance of airway safety constitute difficulties for anesthesists7,8. Despite the production of new tools such as new blades, buigies, video laryngoscopes, fiberoptic laryngoscopes Airway management in DBE patients continues to force anesthesia doctors5,7–9. In this study, patients who had undergone surgery for DBE were reviewed retrospectively by scanning 10-year data in our clinic. The primary aim of our study was to create an optimal airway management style for patients with DBE, additionally demographic data, source of infection, history of antibiotic usage, first signs and symptoms, methods of diagnosis, spread areas, culture results, number of days of antibiotic usage and presence of airway obstruction, complications, airway management type, duration of intensive care follow-up and mortality informations were documented. In our study, each unit increase in tracheal compression classification increased the need for video laryngoscope and tracheotomy approximately 6 times (p<005). In the light of these data, we recommend using video laryngoscop and flexible fiberoptic intubation devices or planning an elective tracheostomy in order to save time and reduce the number of unsuccessful attempts if there are signs of tracheal compression clinically or in the radiological imaging of the patients. In addition, we think that it is possible to reduce mortality and morbidity in DNI patients with a well-planned organization, an experienced team and the presence of necessary equipments.