Endotracheal Intubation and Venturi (Jet) Ventilation for Laser Microsurgery of the Larynx

Oxygen flow during pediatric laryngoscopy: A simple solution

“…Infants with chronic lung disease or a compromised airway due to edema or stenosis will tolerate much shorter times of intervention, and this determination is made jointly after consultation with the attending pediatric anesthesiologist. An endotracheal tube compromises full visualization of the operative site and in certain situations presents a fire hazard . An ideal anesthetic technique would maintain a safe airway and adequate oxygenation while not obstructing the operative field.…”

A New Tube for Microlaryngeal Surgery

“…The injector jet technique is capable of maintaining satisfactory conditions for long periods and blood gases have been shown to be satisfactory (Spoerel and Greenway 1973). With some techniques (Norton 1976, Vourch et al 1977 the venturi injector jet is used in the proximal lumen of the laryngoscope and the blast of gas produces unwanted vocal cord movement, drying of the mucosa of the larynx and there is a chance of foreign particulate matter, for example papilloma or blood clot passing into the tracheobronchial tree. None of these problems occur with the tube we have described.…”

“…The techniques which have been used generally come into one or more of the following groupS: No endotracheal tube with controlled respiration using an external chest respirator such as the cuirass; spontaneous respiration with insufflation of anaesthetic gases (Lines 1973); a venturi jet used proximally in the lumen of the laryngoscope (Norton 1976, Vourch et al 1977, Sanders 1967. A standard endotracheal tube used either with the patient paralysed or with the patient breathing spontaneously.…”

Anesthesia for Laser Surgery of the Airway

“…Larynx is either anesthetized with blocks or topical anesthesia and the patient induced with standard drugs like thiopentone or propofol along with fentanyl and midazolam. [16][17][18][19][20] Anesthesia is maintained using a nitrous oxide-oxygen mixture with a noninflammable agent like isoflurane/sevoflurane [17][18][19] via nasal catheters. The other method is to give relaxant while maintaining depth with propofol while jet ventilating the patient.…”

“…The other method is to give relaxant while maintaining depth with propofol while jet ventilating the patient. [19][20][21][22] However, one has to be aware of the complications of jet ventilation: Pneumothorax, pneumomediastinum, inflation of stomach, aspiration of resected material, dehydration of mucosal surface, etc. In this method, the surgeon and anesthetist alternately share the airway.…”