Undergoing a procedure (i.e. colonoscopy) by sedation or surgery by either local or general anesthesia is challenging for laryngectomees. I personally realized this when I needed surgery for an inguinal hernia that emerged after a bout of coughing.

Unfortunately, most of the medical personal that take care of a laryngectomees before, during, and after surgery are not familiar with their unique anatomy, how they speak, and how to manage their airways during and after the operation. These include nurses, medical technicians, surgeons and even anesthetists.

It is therefore advisable that neck breathers explain their unique needs and anatomy before the surgery to their surgeon(s) and anesthetists. Using explanatory illustrations or pictures is helpful. Those with voice prosthesis should allow the anesthetist view their stoma so that they understand its function and be warned not to remove it during the surgery. It is helpful to provide the anesthetist the video that illustrates how to ventilate neck breather, or give him/her the link to it on YouTube : (http://www.youtube.com/watch?v=YE-n8cgl77Q).

The medical personal should understand that in those with total laryngectomy there is no connection between the esophagus and trachea and therefore ventilation and airways suctioning should be done through the stoma and not the nose and mouth.

Undergoing a procedure with sedation or surgery under local anesthesia is very challenging because speaking with an electro-larynx or voice prosthesis is generally not possible. The stoma is covered by an oxygen mask, and the hands are bound. However, individuals who use esophageal speech can communicate throughout the surgery if needed.

My recent experience as a patient taught me the importance of discussing my special requirements with the staff prior to surgery. I had to explain my condition several times, first to surgeons, than to the anesthetist who examined me in the pre surgical visit, and lastly on the day of surgery to the anesthesia team that was actually going to be in the operating room. I was going to be mildly sedated during the hernia repair and receive local anesthetics injected by the surgeons that would numb the site of operation.

Prior to the surgery I coordinated with the anesthetist how I would let him know that I have pain, or need to be suctioned. I was going to use rudimentary esophageal speech by verbalize “Paa” to inform him that I experience pain and “Suc” to request suctioning. I requested my surgeon to ask me if I have pain whenever she suspects that the procedure she plans to perform may cause it, and I would node my head for “Yes” or “No”. The anesthetist would convey my response to her.

These pre surgical planning paid off, and I had minimal discomfort or pain throughout the two and a half hour long surgery. Fortunately my anesthetist was also able to read my lips which made it easier to communicate.

I am hopeful that using these suggestions would help laryngectomees get adequate care whenever they undergo a medical procedures or surgery.

I will be happy to have the video “ Rescue Breathing for Laryngectomees and Neck Breathers” sent if you request it from me. Please send me a request with your address to : ib6@georgetown.edu
Original Post
NALC, the National Association of Laryngectomee Clubs, has an education programme delivered in some parts of the UK to nurses, the ambulance service and others to overcome problems dealing with laryngectomees.
We also are involved with the National Tracheostomy Safety Project which aims to ensure the safety of neck-breathers and tracheostomy patients in hospital and elsewhere.

www.laryngectomy.org.uk

www.tracheostomy.org.uk

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