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The approach to a difficult airway in patients presenting with recurrent head and neck tumors in the setting of previous surgery or radiation poses challenges to both anesthesiologists and otolaryngologists. Multidisciplinary planning with close communication is required for effective and safe care. It is critical to understand how each patient's prior surgery and radiation distorts the baseline airway anatomy and what complications may arise when deciding on the primary airway management and back-up plans. Preoperative imaging, flexible laryngoscopy, and airway ultrasound may be incorporated into the decision-making process in addition to the traditional airway exam. While awake airway management techniques will be very common in this patient population, anticipating potential problems, back-up planning, flexibility, and teamwork are essential for optimal patient outcomes. This article will review the common challenges encountered during airway management in this population.

Intraoperative anesthetic technique directly impacts immediate postoperative recovery, yet there are few opportunities for anesthesiologists to receive feedback and no easily available benchmarks, making it difficult to reflect on one's own practice. This initial implementation study used retrospective data from 5,712 ambulatory surgery cases with healthy adult patients undergoing general anesthesia in 2018 at a large tertiary care academic center. It examines variation in practice among anesthesiologists for eight surgical specialties. Scorecards assessing intraoperative and postoperative opioids, antiemetics, nonopioid analgesics, regional blocks, recovery time, and severe postoperative pain compared with peers were given to anesthesiologists with prefeedback and postfeedback surveys assessing their attitudes toward feedback. Before receiving their scorecard, 71% of providers predicted their performance was average, and 29% predicted their performance was above average. After receiving their scorecards, 42% rated their quality of recovery as worse than expected, 42% rated it as expected, and 16% rated it as better than expected. Thirteen percent disagreed, 44% were neutral, and 44% agreed that this feedback will change their practice. Implementing a scorecard of patient-centered measures that shows where an anesthesiologist stands in the distribution of their peers was well-received, provides a benchmark, and has the potential to change practice.