Apneic Anesthesia With Intermittent Ventilation for Microsurgery of the Upper Airway

Abstract

Apneic anesthesia with intermittent ventilation (AAIV) has been used in 250 procedures on the larynx and trachea at Indiana University Medical Center since October 1989. Initially employed for laryngeal papilloma removal in children, this anesthetic technique is now used for other procedures and in adult patients. The advantages of AAIV include improved visualization of the airway, absence of combustible material, and lack of vocal cord motion during surgery. No significant complications have occurred with AAIV. The high degree of safety for this anesthetic technique relates largely to the constant monitoring of oxygen saturation using pulse oximetry and the periodic measurement of end-tidal carbon dioxide (CO2) levels. Contraindications to AAIV are age less than 2 years, significant cardiopulmonary disease, and any hypermetabolic state. Relevant pulmonary physiology includes the unique aspects of oxygen and CO2 metabolism in children.

Feasibility of standard mechanical ventilation with low FiO2 and small endotracheal tubes during laser microlaryngeal surgery

“…Complications such as hypercarbia, hypoxemia, laryngospasm, inhalation of gastric liquid, and the need to periodically stop surgery to resume ventilation can occur. 20,21 Controlled mechanical ventilation via small laser-safe ETT possibly offers adequate gas exchange. On the other hand, to optimize vision and access to the larynx, small caliber ETTs are required.…”

Clinical Features and Surgical Outcomes Following Closed Reduction of Arytenoid Dislocation

“…Arytenoid manipulation procedures were then performed during apneic anesthesia with intermittent ventilation. 13 Immediately prior to CR, intraoperative arytenoid palpation was performed to confirm the diagnosis and rule out arytenoid fixation.…”

A non-tracheal intubation (tubeless) anesthetic technique with spontaneous respiration for upper airway surgery

“…Tubeless techniques, in which tracheal intubation is not used, are under investigation by a number of groups worldwide. ese techniques, including jet ventilation [1][2][3] and the apneic method with intermittent ventilation [4], can provide a satisfactory surgical approach, but certain problems are still present. Patients undergoing jet ventilation receive a neuromuscular block that o en makes diagnostic observations of the larynx or trachea impossible a er endoscopic insertion.…”