Anesthesia for Laryngeal Laser Surgery in the Infant and Child

Brummitt, W. M.; Fearon, Blair; Brama, I.

doi:10.1177/000348948109000512

Cited by 19 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Narcotics and muscle relaxants cannot be used because of the risk of suppression of spontaneous respiration. 31 The major objection to this technique is risk to operating room personnel from the anesthetic gases released into the room. 31 • 34 • 35 Since no endotracheal tube is used, it is impossible to create a closed sys-te~.…”

Section: Spontaneous Respiration This Techniquementioning

confidence: 99%

Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Hunsaker

1994

The Laryngoscope

View full text Add to dashboard Cite

Although the techniques for surgery on the endolarynxusing suspension and the operating microscope have been fully developed,1–4 the safest, and least obtrusive anesthetic technique has yet to be manifested, as evidenced by more than 200 references to anesthesia for microlaryngoscopy in the world literature. This study reviews the physiology, physics, and problems of each anesthetic technique. In light of this review, animal and human studies are reported demonstrating the utility and safety of subglottic ventilation when provided with proper monitoring using an automatic ventilator. A modified Ben‐Jet tube is reported,5 which has a 1‐mm ID channel to monitor Pco2 and tracheal pressure. This self‐centering 3.0‐mm tube, which extends 6 to 8 cm below the glottis, is unobtrusive for the surgeon. The subglottic tube, which is much less likely to be malaligned, is much more acceptable to the anesthesiologist. Anesthesia, by intravenous sedation, utilizes neuromuscular blockade while ventilating through the jet tube powered by an automatic ventilator with an automatic shutdown feature attached to the monitor tube to prevent inadvertent barotrauma. The third phase of this study compared fluoroplastic, used in a prototype jet ventilation tube, with 6‐mm Silastic®, Red Rubber, and polyvinyl chloride (PVC) tubes when struck by maximum power of CO2, Nd‐YAG, and K‐532 lasers. The test was performed in a closed chamber in which concentrations of oxygen and nitrogen were controlled. Although damaged by the CO, laser beam, the fluoroplastic tubes did not continue burning when the laser was turned off in 100% oxygen, even when coated by blood. The other three tubes continued to burn in 23% oxygen. Neither the KTP nor Nd‐YAG laser damaged the Teflon tube, while they ignited a sustained flame in 30% oxygen. This study supports the use of fluoroplastic for a laser safe jet ventilation tube. It also demonstrates the danger of tube fires, even in low oxygen concentrations, when using Silastic, rubber, and PVC tubes in laser laryngeal surgery. There was no difference in the flammability of Silastic, rubber or PVC when struck by these lasers in this study. For these reasons, subglottic ventilation using a fluoroplastic, monitored, self‐centering, subglottic, jet ventilation tube driven by an automatic ventilator with a shutdown feature, in the event of excessive pressure buildup, is proposed for anesthetizing healthy patients undergoing suspension microlaryngoscopy, and who have no airway obstructing lesion. A large tube with inflatable cuff is indicated when a supraglottic lesion may obstruct the airway.

show abstract

Section: Spontaneous Respiration This Techniquementioning

confidence: 99%

Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Hunsaker

1994

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…Accepted for publication: August 16, 2001 Diagnostic or surgical laryngoscopy requires a method that can give good exposure of the larynx, continuous control of airway patency, and immobility of the vocal cords. Techniques suggested include spontaneous ventilation under light anaesthesia in adults or deep anaesthesia in children, 1 an apnoeic technique, especially in children, 2 intermittent positive pressure ventilation via a small microlaryngeal tube, 3 manual jet ventilation at a normal ventilatory frequency 4 or high frequency jet ventilation (HFJV). 5 Most require speci®c skills and equipment, which is why none have gained general acceptance.…”

mentioning

confidence: 99%

Transtracheal high frequency jet ventilation for endoscopic airway surgery: a multicentre study

Bourgain

Desruennes

Fischler

et al. 2001

British Journal of Anaesthesia

124

View full text Add to dashboard Cite

Serious complications during high frequency jet ventilation (HFJV) are rare and have been documented in animals and in case reports or short series of patients with a difficult airway. We report complications of transtracheal HFFJV in a prospective multicentre study of 643 patients having laryngoscopy or laryngeal laser surgery. A transtracheal catheter could not be inserted in two patients (0.3%). Subcutaneous emphysema (8.4%) was more frequent after multiple tracheal punctures. There were seven pneumothoraces (1%), two after laser damage to the injector, one after difficult laryngoscopy, four with no clear cause. Arterial desaturation of oxygen was more frequent during laser surgery and in overweight patients. Transtracheal ventilation from a ventilator with an automatic cut-off device is a reliable method for experienced users. Control of airway pressure does not prevent a low frequency of pneumothorax.

show abstract

“…For adequate protection, personnel in the immediate proximity (especially the surgeon and anesthesiologist) should wear an oxygen (or air) mask, or an activated charcoal absorbent mask. 9 The term subglottic stenosis has been used with less precision recently, particularly by specialists in fields other than otolaryngology. By definition, the term applies to a narrowing or stricture of the subglottic larynx: the region extending from the insertion of the conus elasticus into the vocal cords to the inferior margin of the cricoid cartilage; the upper trachea is not included.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Severe Subglottic Stenosis without Tracheotomy

Holinger¹

1982

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Subglottic stenosis in neonates, infants and children is one of the most challenging problems confronting the pediatric otolaryngologist today. Small patients with congenital or acquired stenosis were enough to require tracheotomy must undergo repeated endoscopic procedures or laryngotracheal reconstruction; weeks, months, or years may be required to attain a lumen large enough to permit decannulation. During 1981, six infants and children with severe subglottic stenosis were managed without tracheotomy. The surgical technique employed involves endoscopic excision of the offending subglottic tissue using the CO2 laser and suspension microlaryngoscopy. Intraoperative intubation is avoided by using an insufflation technique for general anesthesia which permits unobstructed visualization of the larynx, thereby avoiding laryngeal trauma and edema.

show abstract

Anesthesia for Laryngeal Laser Surgery in the Infant and Child

Cited by 19 publications

References 8 publications

Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Transtracheal high frequency jet ventilation for endoscopic airway surgery: a multicentre study

Treatment of Severe Subglottic Stenosis without Tracheotomy

Contact Info

Product

Resources

About