61 year old male for EUA and nasopharyngeal biopsy – ? recurrence of nasopharyngeal B cell lymphoma.

Background

1. Nasopharyngeal B cell lymphoma 2020
2. Diagnosed in China in 2020 where patient was working
3. Treatment with chemotherapy (R-CHOP x 5)
4. Prolonged hospital admission and repatriation back to Australia
5. Complicated by recurrent aspiration pneumonia despite PEG tube, upper limb DVT requiring anticoagulation, MSSA bacteraemia due to CVC infection.
6. Severe depression post discharge – currently on Mirtazepine.
7. Ex-smoker (40 pack years)
8. SCC neck 3 years ago. Surgical resection of superficial SCC and lymph nodes.

Issues

• Phone consultation – however patient only able to answer yes/no to questions. Further information via D/C summary Concord hospital and niece.
• Limited airway assessment on phone!
• Aspiration risk. Ensure PEG feeds ceased at normal fasting times.

Discussion

• Difficulty of airway assessment for phone consultation was discussed. In particular the head and neck and ENT surgical patient population. Note that most ENT patients have FNE documented at their outpatient appointment on DMR. There is no photos, however detailed descriptions are made. Therefore do we need further airway assessment! The pros and cons of further assessment for airway planning was discussed. This patient had multiple featues of difficult airway and aspiration risk.
• Airway management for procedure. Pros and cons of ETT vs THRIVE were discussed. Note recurrent aspiration despite PEG. Question raised : does THRIVE increase aspiration risk? Limited evidence noted.
• Short notice patient seen 1 day prior to surgery. Phone call to treating anaesthetist to ‘pre-warn’ them of patient on list.