Head and Neck Anesthesia and Advanced Airway Management
Welcome to Stanford Head and Neck Anesthesia and Advanced Airway Management Program!
Our group is one of the largest and busiest in the multispecialty anesthesia division (MSD) of the Department of Anesthesiology, Perioperative and Pain Medicine. Formally established in 1998, it currently includes 10 faculty anesthesiologists with a special interest and expertise in H&N anesthesia and advanced airway management, also making it to our knowledge the largest academic H&N anesthesia group in the country. Current faculty members include: Dr. Vladimir Nekhendzy (Chief of the Division and SAAMP Director), Dr. Alexander Butwick, Dr. Tiffany Cheng, Dr. David Drover, Dr. Sara Goldhaber-Fiebert, Dr. Brita Mittal, Dr. Amit Saxena, Dr. Jewel Sheehan, Dr. Anil Panigrahi and Dr. Victoria Yin.
Our missions are:
- To provide the state-of-the art perioperative patient care in H&N anesthesia
- To maintain and advance group’s leadership position in the field of H&N anesthesia through excellence in clinical care, education, and research
- To provide comprehensive, up-to-date education in H&N anesthesia and advanced airway management to the trainees
- To foster collegiate relationship with H&N surgeons and other providers involved in perioperative care of patients undergoing H&N surgeries
- To promote and maintain professional honesty, transparency and collaboration between the members of H&N anesthesia team
In clinical care, we cover 3-6 operating rooms daily. The diverse surgical procedures range from major head and neck cancer and thyroid surgery to laryngologic, neurotologic, and skull base surgery, surgery for obstructive sleep apnea (OSA), transoral robotic surgery (TORS), oromaxillofacial and orthognatic surgery, facial cosmetic surgery, and others.
Over the years, our group has developed many special anesthetic protocols aimed at improving surgical outcomes, diminishing intraoperative airway morbidity, and increasing patient satisfaction. Some of the examples of our work include:
- Stratified use of different opioid infusions
- Predominant use of total intravenous anesthesia (TIVA) with routine intraoperative hypnotic monitoring
- A focused elective teaching of the advanced airway management devices and techniques for specific surgical procedures
- Protocols for proper positioning and securing of the neural monitoring (NIM) endotracheal tubes (ETTs) for thyroid/parathyroid and skull base surgery
- Protocols for safe techniques of nasal intubation and securing nasal ETTs for MMA and TORS surgery
- Protocol for dexmedetomidine use for drug-induced sleep endoscopy (DISE)
- Anesthetic protocol for office-based facial cosmetic surgery
- Protocols for supraglottic airway (SGA) ventilation without immediate access to the patient’s airway
- Routine use of the preoperative endoscopic airway examination (PEAE) for complex H&N cases with known or suspected airway compromise, following NAP4 recommendations
- Protocols for the use of THRIVE for laryngologic surgery. Our division pioneered the use of THRIVE for intraoperative clinical use in the U.S. in 2015.
In clinical and didactic teaching, a formal H&N Anesthesia/Advanced Airway Management rotation accommodates 2 residents per month. It has been consistently ranked among the top 4 Stanford-based rotations of the residency program, and was voted the best rotation in 2015 and 2016. The rotation offers a carefully compiled curriculum with clearly defined, ACGME-compliant teaching goals and objectives. A structured resident’s portfolio allows the rotation faculty and the residents to monitor the teaching/learning process.
Over the years, we have been privileged to share our clinical and teaching experience nationally and internationally. Our leading role in comprehensive resident education has been recognized by the international Society for Head and Neck Anesthesia (SHANA; www.shanahq.com), which has adopted its goals, objectives and curriculum after Stanford’s H&N Anesthesia program.
The Stanford Advanced Airway Management Program (SAAMP) was established in 1998, and is an integral part of H&N anesthesia training program. Originally started as a simple teaching course on flexible fiberoptic intubation, SAAMP had gradually grown into an annual, weekend-long didactic and hands-on airway course for Stanford anesthesia residents, faculty, and critical care fellows. Since 2012, SAAMP offers Stanford CME Advanced Airway Management and Fiberoptic Course to national and international audience. It provides unique, multidisciplinary overview of the airway problems and their best practice solutions in the operating room, emergency department, and critical care settings. The course offers over 30 evidence based lectures and case-based discussions, 12 state of the art airway stations, and an integrated, 6 station fiberoptic intubation course.
Led by H&N Anesthesia Group, SAAMP currently includes over 30 faculty members from the departments of anesthesiology, emergency medicine, and otolaryngology-head and neck surgery. SAAMP members have presented lectures and hands-on courses nationally and internationally, in countries such as Brazil, Indonesia, China, South Africa, Israel, Switzerland, Ireland, U.K. and others, training over 1,300 airway practitioners.
In 2009, our H&N Anesthesia Division bolstered its leadership by establishing a one-year clinical fellowship in H&N Anesthesia and Advanced Airway Management, the first fellowship of this kind in the U.S. The fellowship is highly structured and integrates didactic, clinical, difficult airway simulation and research components. A high case volume and a large number of H&N anesthesia faculty make it possible to train up to 2 fellows per year. A full description of the fellowship is available at http://med.stanford.edu/anesthesia/education/fellowships/clinical-fellows/head_neck.html and in the Fellowship Training section on this site. The Stanford fellowship experience is guiding the SHANA’s mission for promoting advanced education in H&N anesthesia globally.
Stanford’s H&N Anesthesia Group continues to provide excellence in clinical services, education and research at Stanford. We welcome you to our educational resources and to our growing community!
Vladimir Nekhendzy, M.D.
Clinical Professor of Anesthesia and Otolaryngology
Director, Stanford Head & Neck Anesthesia & Advanced Airway Management Program (SAAMP)
Past President, Society for Head and Neck Anesthesia (SHANA)