Laser treatment for tracheobronchial tumours: local or general anaesthesia?

Abstract

Ninety seven patients with tracheobronchial tumours have been treated with the neodymium yttrium-aluminium-garnet (Nd YAG) laser over a period of 33 months. Fifty one of these patients were treated under local anaesthesia and 46 under general anaesthesia. The results obtained with the two methods have been compared retrospectively. The numbers of patients responding to treatment, the magnitude of the response, and the duration of palliation were similar in the two groups; significantly more treatment sessions, however, were required during each course of treatment under local anaesthesia. This advantage of general anaesthesia was thought to arise from the ability to continue treatment for longer and with greater efficiency. The use of the rigid bronchoscope with jet ventilation under general anaesthesia was also thought to provide better control of the airway and to allow more efficient clearance of blood and mucus. Two operative deaths occurred under local anaesthesia, when bleeding led to asphyxiation, but none have occurred under general anaesthesia. Treatment under general anaesthesia is not, however, without risk and is potentially hazardous in patients with severe chronic hypoxic lung disease.During the last six years the neodymium yttriumaluminium-garnet (Nd YAG) laser has become established as an important method of palliative treatment in patients with tracheobronchial tumours." The thermal action of the laser is used to resect and cauterise intraluminal tumour within the proximal tracheobronchial tree and breathlessness and haemoptysis can be relieved in selected patients.Treatment may be given under either local or general anaesthesia. Although each method has gained favour among different groups, no attempt has been made to compare them. We describe our experience with both methods in two hospitals. Methods DESIGN OF THE STUDYThe results of treating patients under local and general anaesthesia have been compared in a retrospective study. Our initial experience with the Nd YAG laser was obtained with local anaesthesia. It is therefore possible that our early data on local Address for reprint requests: Dr P J M George, University College Hospital, London WC1E 6AU. Accepted 7 March 1987anaesthesia might be prejudiced by lack of experience with a new technique. To reduce possible bias in favour of general anaesthesia, the data on local anaesthesia obtained during our first 18 months' work with the laser have been discarded and more recently acquired data relating to local anaesthesia have been compared with our earliest data on general anaesthesia. PATIENTSDuring the period of the study, 51 patients (33 men and 18 women) were treated under local anaesthesia (January 1983 to September 1985

Central airway obstruction caused by a peripheral hamartoma

“…Our attempts to debulk the hamartoma with biopsy forceps were unsuccessful due to its firm and elastic nature, whereas vaporisation with the YAG laser proved to be efficient and safe. Although our normal practice is to resect tumour via a rigid bronchoscope [6], this would have been unduly hazardous as the unusually long and mobile tumour would have become impacted in the lower trachea as occurred before referral to our unit. However, laser vaporisation via an endotracheal tube with conventional ventilation provided a safe alternative in extremely difficult circumstances.…”

Diagnóstico e estadiamento do câncer de pulmão

“…Proporciona, também, melhor aspiração da árvore respiratória, melhor controle dos sangramentos e permite a ressecção tumoral endoscópica (13) . É o procedimento de escolha, para alguns autores, para a colocação dos suportes endobrônquicos e para a ressecção endobrônquica com laser ou eletrocautério (14) .…”

Resection of Endobronchial Tumors Using a Tracheoscope and Neodymium: YAG Laser

“…Insufficient suction and difficulties in controlling hemorrhage makes the fiberscope unsuit able for the resection of larger tumors. For the same rea sons, the use of only a fiberscope is generally not recom mended [3,4,11].…”

“…The use of flexible fiberscopes for the resection of larger tumors is generally not recom mended [3,4], Obstructions of the trachea or the very proximal main bronchi may be reached through a tra cheoscope with a CO2 laser, guided by direct vision through an operating microscope [5]. Tumors of the same or a more distal location may also be removed by a CO2 laser coupled to a rigid bronchoscope [6,7], Lim itations with this method have led to the widespread use of neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers introduced through rigid bronchoscopie systems [4,8], The main advantages of this laser type are the de livery of energy through optical fibers and good hemo stasis.…”

“…Only the use of rigid bronchoscopes [8] and general anesthesia [3] ensures a direct reach of the operative field and enough suction to clear mucus, smoke, and blood. These conditions are essential for the proper man agement of intraoperative difficulties such as hemor rhage and hypoxia.…”