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International Bulletin of Otorhinolaryngology

Airway management for microlaryngeal surgery

Ts. Marinov, M. Belitova, T. Popov, N. Nizamova, J. Rangachev, D. Popova

Abstract

Theoretical basis: Microlaryngeal surgery can be conducted in an awake patient, frequently under conscious sedation, or with the patient anesthetized. The ventilation options under general anesthesia consist of “tube” (i.e., endotracheal intubation) and “tubeless” techniques, with the latter represented by the techniques of Spontaneous ventilation, Apneic intermittent ventilation (AIV), and Jet Ventilation (JV). Results: The use of a small (5.0-mm ID) MLT tube with positive-pressure ventilation remains the standard for airway management in most nonlaser microlaryngeal surgery, and it is associated with minimal or no intraoperative complications. Spontaneous ventilation is rarely used in adult microlaryngeal surgery, but it is commonly employed in the pediatric patient population. AIV remains a relatively popular technique for microlaryngeal surgical procedures of short duration in some surgical centers. Superimposed High-Frequency Jet Ventilation (SHFJV), which combines highfrequency and low-frequency ventilation modes, has been used effectively in surgical treatment of high-grade laryngeal and tracheal stenosis. Conclusion: General anesthesia for microlaryngeal surgery represents a unique example of close cooperation between the surgeon and the anesthesiologist.

Keywords

Microlaryngeal surgery, general anesthesia, ventilation techniques

Full Text


References

Brooker CR, Hunsaker DH, Zimmerman AA: A new anesthetic system for microlaryngeal surgery. Otolaryngol Head Neck Surg 118:55–60, 1998.

Ku PK, Tong MC, Kwan A, van Hasselt CA: Modified tubeless anesthesia during endoscopy for assessment of head and neck cancers. Ear Nose Throat J 82:121–125, 2003.

Yung KC, Courey MS: The effect of office-based flexible endoscopic surgery on hemodynamic stability. Laryngoscope 120:2231–2236, 2010.

Drummond GB: Comparison of sedation with midazolam and ketamine: Effects on airway muscle activity. Br J Anaesth 76:663–667, 1996.

Hillman DR, Platt PR, Eastwood PR: Anesthesia, sleep, and upper airway collapsibility. Anesthesiol Clin 28:443–455, 2010.

Bourgain JL, Desruennes E, Fischler M, et al: Transtracheal high frequency jet ventilation for endoscopic airway surgery: A multicentre study. Br J Anaesth 87:870–875, 2001.

Jaquet Y, Monnier P, Van Melle G, et al: Complications of different ventilation strategies in endoscopic laryngeal surgery: A 10-year review. Anesthesiology 104:52–59, 2006.

Cinar SO, Coskun BU, Cinar U, et al: Blood gas changes in patients undergoing laryngeal microsurgery. Auris Nasus Larynx 33:299–302, 2006.

Nicelli E, Gemma M, De Vitis A, et al: Feasibility of standard mechanical ventilation with low Fio2 and small endotracheal tubes during laser microlaryngeal surgery. Head Neck 32:204–209, 2010.

Kawaida M, Fukuda H, Kohno N: Microlaryngosurgery for benign posterior glottal lesions using a posterior glottis direct laryngoscope. ORL J Otorhinolaryngol Relat Spec 63:127–130, 2001.

Strong MS: Microscopic laryngoscopy. A review and appraisal. Laryngoscope 80:1540–1552, 1970.

Ossoff RH, Duncavage JA: Adult subglottiscope for laser surgery. Ann Otol Rhinol Laryngol 97(Pt 1):552–553, 1988.

Talmage EA: Safe combined general and topical anesthesia for laryngoscopy and bronchoscopy. South Med J 66:455–459, 1973.

Judelman H: Anaesthesia for laryngoscopy and microsurgery of the larynx. S Afr Med J 55:698, 1979.

Sun KO: Doxapram in tubeless anaesthesia for microlaryngeal surgery. Anaesth Intensive Care 21:250–251, 1993.

Weigand H: Circulatory response to endolaryngeal microsurgery under light general anesthesia and the influence of surface anesthesia. Anesth Analg 48:953–957, 1969.

Weisberger EC, Emhardt JD: Apneic anesthesia with intermittent ventilation for microsurgery of the upper airway. Laryngoscope 106:1099–1102, 1996.

Nelson RA, Miller T: Apneic anesthesia for microlaryngeal surgery. Laryngoscope 83:1228–1233, 1973.

Barr AM, Wong RM: Awareness during general anaesthesia for bronchoscopy and laryngoscopy using the apnoeic oxygenation technique. Br J Anaesth 45:894–900, 1973.

Sebel PS, Bowdle TA, Ghoneim MM, et al: The incidence of awareness during anesthesia: A multicenter United States study. Anesth Analg 99:833–839, 2004.

Albert SN, Shibuya J, Albert CA: Ventilation with an oxygen injector for suspension laryngoscopy under general anesthesia. Anesth Analg 51:866–870, 1972.

Aloy A, Schachner M, Cancura W: Tubeless translaryngeal super¬imposed jet ventilation. Eur Arch Otorhinolaryngol 248:475–478, 1991.

Grasl MC, Donner A, Schragl E, Aloy A: Tubeless laryngotracheal surgery in infants and children via jet ventilation laryngoscope.

Laryngoscope 107:277–281, 1997.

Orloff LA, Parhizkar N, Ortiz E: The Hunsaker Mon-Jet ventilation tube for microlaryngeal surgery: Optimal laryngeal exposure. Ear Nose Throat J 81:390–394, 2002.

Barakate M, Maver E, Wotherspoon G, et al: Anaesthesia for microlaryngeal and laser laryngeal surgery: Impact of subglottic jet ventilation. J Laryngol Otol 124:641–645, 2010.

Hautmann H, Gamarra F, Henke M, et al: High frequency jet ventilation in interventional fiberoptic bronchoscopy. Anesth Analg 90:1436–1440, 2000.

Young SS, Wang SJ, Lin SY, et al: An urgent technique of applying high frequency jet ventilation in patients with extreme periglottic stenosis. Acta Anaesthesiol Sin 33:63–68, 1995.

Borg U, Eriksson I, Sjöstrand U: High-frequency positive pressure ventilation (HFPPV): A review based upon its use during bronchoscopy and for laryngoscopy and microlaryngeal surgery under general anesthesia. Anesth Analg 59:594–603, 1980.

Shikowitz MJ, Abramson AL, Liberatore L: Endolaryngeal jet ventilation: A 10-year review. Laryngoscope 101:455–461, 1991.

Ravussin P, Freeman J: A new transtracheal catheter for ventilation and resuscitation. Can Anaesth Soc J 32:60–64, 1985.

Gerig HJ, Heidegger T, Ulrich B, et al: Fiberoptically guided insertion of transtracheal catheters. Anesth Analg 93:663–666, 2001.

Vourch G, Fischler M, Michon F, et al: High frequency jet ventilation v. manual jet ventilation during bronchoscopy in patients with tracheobronchial stenosis. Br J Anaesth 55:969–972, 1983.

Bacher A, Lang T, Weber J, et al: Respiratory efficacy of subglottic low-frequency, subglottic combined-frequency, and supraglottic combinedfrequency jet ventilation during microlaryngeal surgery. Anesth Analg 91:1506–1512, 2000.

Patel A, Rubin JS: The difficult airway: The use of subglottic jet ventilation for laryngeal surgery. Logoped Phoniatr Vocol 33:22–24, 2008.

Sanders RD: Two ventilating attachments for bronchoscopes. Del Med J 192:170–175, 1967.

Gaitini LA, Fradis M, Vaida SJ, et al: Pneumomediastinum due to Venturi jet ventilation used during microlaryngeal surgery in a previously neck-irradiated patient. Ann Otol Rhinol Laryngol 109:519–521, 2000.

Bourgain JL, McGee K, Cosset MF, et al: Carbon dioxide monitor¬ing during high frequency jet ventilation for direct laryngoscopy. Br J Anaesth 64:327–330, 1990.

Young JD, Sykes MK: Assisted ventilation. 1. Artificial ventilation: history, equipment and techniques. Thorax 45:753–758, 1990.

Ng A, Russell WC, Harvey N, et al: Comparing methods of admin¬istering high-frequency jet ventilation in a model of laryngotracheal stenosis. Anesth Analg 95:764–769, 2002.

Rezaie-Majd A, Bigenzahn W, Denk DM, et al: Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal

surgery in more than 1500 patients. Br J Anaesth 96:650–659, 2006.

Lanzenberger-Schragl E, Donner A, Grasl MC, et al: Superimposed high-frequency jet ventilation for laryngeal and tracheal surgery. Arch Otolaryngol Head Neck Surg 126:40–44, 2000.

Ihra G, Hieber C, Adel S, et al: Tubeless combined high-frequency jet ventilation for laryngotracheal laser surgery in paediatric anaesthesia. Acta Anaesthesiol Scand 44:475–479, 2000.

Kraincuk P, Körmöczi G, Prokop M, et al: Alveolar recruitment of atelectasis under combined high-frequency jet ventilation: A computed tomography study. Intensive Care Med 29:1265–1272, 2003.




DOI: http://dx.doi.org/10.14748/orl.v16i3.7251

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