Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Tubeless Spontaneous Respiration Technique for Pediatric Microlaryngeal Surgery

Tubeless Spontaneous Respiration Technique for Pediatric Microlaryngeal Surgery Abstract Background: Tubeless spontaneous respiration technique for pediatric microlaryngeal surgery may be accomplished using different anesthetic protocols. Two methods, inhalation of volatile anesthetic agents alone and in combination with intravenous propofol, are reviewed with regard to intraoperative airway stability, post-operative morbidity, recovery room course, and halothane concentration required during maintenance anesthesia. Design: Retrospective case series. Setting: Otolaryngology referral hospital. Patients and Methods: Twenty-nine microlaryngeal procedures were performed using tubeless spontaneous respiration technique in children ranging from 2 weeks to 11 years of age. The following 2 anesthetic protocols were used: inhaled volatile anesthetic agents alone in 18 procedures and in combination with intravenous propofol in 11. Anesthesia, surgery, and recovery room times were documented. Specific characteristics of anesthetic maintenance, including total anesthetic gas flow (liters per minute), variations of halothane concentration (percentage), and duration of halothane administration (minutes) were also recorded to calculate the mean concentration of halothane (percentage) delivered to each patient. Results: No statistical differences were observed between the 2 protocols in terms of anesthesia and surgical outcomes. Adjusting for differences in patient age, weight, maintenance duration, and total anesthetic gas flow, the introduction of propofol allowed a statistically significant reduction in the mean concentration of halothane required during maintenance anesthesia. Conclusions: Both tubeless spontaneous respiration technique protocols proved successful in this study. However, the addition of propofol allowed a significant reduction in the halothane requirement during anesthesia maintenance. This has the potential benefit of decreasing the exposure of operating room personnel to volatile anesthetics during tubeless spontaneous respiration technique.Arch Otolaryngol Head Neck Surg. 1997;123:209-214 References 1. Hawkins DB, Joseph MM. Avoiding a wrapped endotracheal tube in laser laryngeal surgery: experiences with apneic anesthesia and metal laser-flex endotracheal tubes . Laryngoscope . 1990;100:1283-1287. 2. Ferrari LR, Vassalo SA. Anesthesia for otorhinolaryngology procedures . In: Todres D, Ryan J, Cote C, Goudsouziann N, eds. A Practice of Anesthesia for Infants and Children . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1993:chap 18. 3. Benjamin B. Anesthesia for laryngoscopy . Ann Otol Rhinol Laryngol. 1984;93:338-342. 4. Weisberger EC, Miner JD. Apneic anesthesia for improved endoscopie removal of laryngeal papillomata . Laryngoscope . 1988;98:693-697.Crossref 5. Parsons DS, Lockert JS, Martin TW. Pediatric endoscopy: anesthesia and surgical techniques . Am J Otolaryngol. 1992;13:271-283.Crossref 6. Brummitt WM, Fearon B, Brama I. Anesthesia for laryngeal laser surgery in the infant and child . Ann Otol. 1981;90:475-477. 7. Talmage EA. Safe combined general and topical anesthesia for laryngoscopy and bronchoscopy . South Med J. 1973;66:455-459.Crossref 8. Williams SR, van Hasselt CA, Aun CST, et al. Tubeless anesthetic technique for optimal carbon dioxide laser surgery of the larynx . Am J Otolaryngol. 1993;14:271-274.Crossref 9. Manschot HJ, Meursing EE, Axt P, et al. Propofol requirements for induction of anesthesia in children of different age groups . Anesth Anaig. 1992:75:876-879. 10. Matt BH. Suspension platform for stable microlaryngoscopy . Otolaryngol Head Neck Surg. 1993;108:199-200. 11. Pelton DA, Daly M, Cooper MA, et al. Plasma lldocaine concentrations following topical aerosol application to the trachea and bronchi . Can Anaesth Soc J. 1970;17:250-255. 12. Guinard JP. Laryngospasm-induced pulmonary edema . Int J Pediatr Otolaryngol. 1990;20:163-168.Crossref 13. Saunders RD. Two ventilating attachments for bronchoscopes . Del Med J. 1967;39:170-192. 14. Weeks DB. Laboratory and clinical description of the use of a jet venturi ventilator during laser microsurgery of the glottis and subglottis . Anesth Rev. 1985;12:32-36. 15. Fearon B, MacRae D. Laryngeal papillomatosis in children . J Otol. 1976;5:493-496. 16. Benjamin B. Diagnostic Laryngology: Adults and Children . Philadelphia, Pa: WB Saunders Co; 1990:24-32. 17. Aun CST, Houghton IT, So HY, et al. Tubeless anesthesia for microlaryngeal surgery . Anesth Intensive Care . 1990;18:497-503. 18. Kennedy MG, Chinyanga HM, Steward DJ. Anaesthetic experience using a standard technique for laryngeal surgery in infants and children . Can Anaesth Soc J. 1981;28:561-566. 19. Baden JM, Rice SA. Metabolism and toxicity . In: Miller RD, ed. Anesthesia . 4th ed. New York, NY: Churchill Livingstone Ine; 1994:chap 8. 20. Martin TM, Nicolson SC, Bargas MS. Propofol anesthesia reduces emesis and airway obstruction in pediatric outpatients . Anesth Analg. 1993;76:144-148.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Tubeless Spontaneous Respiration Technique for Pediatric Microlaryngeal Surgery

Loading next page...
 
/lp/american-medical-association/tubeless-spontaneous-respiration-technique-for-pediatric-CgoXO7x0xy
Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1997.01900020097015
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Tubeless spontaneous respiration technique for pediatric microlaryngeal surgery may be accomplished using different anesthetic protocols. Two methods, inhalation of volatile anesthetic agents alone and in combination with intravenous propofol, are reviewed with regard to intraoperative airway stability, post-operative morbidity, recovery room course, and halothane concentration required during maintenance anesthesia. Design: Retrospective case series. Setting: Otolaryngology referral hospital. Patients and Methods: Twenty-nine microlaryngeal procedures were performed using tubeless spontaneous respiration technique in children ranging from 2 weeks to 11 years of age. The following 2 anesthetic protocols were used: inhaled volatile anesthetic agents alone in 18 procedures and in combination with intravenous propofol in 11. Anesthesia, surgery, and recovery room times were documented. Specific characteristics of anesthetic maintenance, including total anesthetic gas flow (liters per minute), variations of halothane concentration (percentage), and duration of halothane administration (minutes) were also recorded to calculate the mean concentration of halothane (percentage) delivered to each patient. Results: No statistical differences were observed between the 2 protocols in terms of anesthesia and surgical outcomes. Adjusting for differences in patient age, weight, maintenance duration, and total anesthetic gas flow, the introduction of propofol allowed a statistically significant reduction in the mean concentration of halothane required during maintenance anesthesia. Conclusions: Both tubeless spontaneous respiration technique protocols proved successful in this study. However, the addition of propofol allowed a significant reduction in the halothane requirement during anesthesia maintenance. This has the potential benefit of decreasing the exposure of operating room personnel to volatile anesthetics during tubeless spontaneous respiration technique.Arch Otolaryngol Head Neck Surg. 1997;123:209-214 References 1. Hawkins DB, Joseph MM. Avoiding a wrapped endotracheal tube in laser laryngeal surgery: experiences with apneic anesthesia and metal laser-flex endotracheal tubes . Laryngoscope . 1990;100:1283-1287. 2. Ferrari LR, Vassalo SA. Anesthesia for otorhinolaryngology procedures . In: Todres D, Ryan J, Cote C, Goudsouziann N, eds. A Practice of Anesthesia for Infants and Children . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1993:chap 18. 3. Benjamin B. Anesthesia for laryngoscopy . Ann Otol Rhinol Laryngol. 1984;93:338-342. 4. Weisberger EC, Miner JD. Apneic anesthesia for improved endoscopie removal of laryngeal papillomata . Laryngoscope . 1988;98:693-697.Crossref 5. Parsons DS, Lockert JS, Martin TW. Pediatric endoscopy: anesthesia and surgical techniques . Am J Otolaryngol. 1992;13:271-283.Crossref 6. Brummitt WM, Fearon B, Brama I. Anesthesia for laryngeal laser surgery in the infant and child . Ann Otol. 1981;90:475-477. 7. Talmage EA. Safe combined general and topical anesthesia for laryngoscopy and bronchoscopy . South Med J. 1973;66:455-459.Crossref 8. Williams SR, van Hasselt CA, Aun CST, et al. Tubeless anesthetic technique for optimal carbon dioxide laser surgery of the larynx . Am J Otolaryngol. 1993;14:271-274.Crossref 9. Manschot HJ, Meursing EE, Axt P, et al. Propofol requirements for induction of anesthesia in children of different age groups . Anesth Anaig. 1992:75:876-879. 10. Matt BH. Suspension platform for stable microlaryngoscopy . Otolaryngol Head Neck Surg. 1993;108:199-200. 11. Pelton DA, Daly M, Cooper MA, et al. Plasma lldocaine concentrations following topical aerosol application to the trachea and bronchi . Can Anaesth Soc J. 1970;17:250-255. 12. Guinard JP. Laryngospasm-induced pulmonary edema . Int J Pediatr Otolaryngol. 1990;20:163-168.Crossref 13. Saunders RD. Two ventilating attachments for bronchoscopes . Del Med J. 1967;39:170-192. 14. Weeks DB. Laboratory and clinical description of the use of a jet venturi ventilator during laser microsurgery of the glottis and subglottis . Anesth Rev. 1985;12:32-36. 15. Fearon B, MacRae D. Laryngeal papillomatosis in children . J Otol. 1976;5:493-496. 16. Benjamin B. Diagnostic Laryngology: Adults and Children . Philadelphia, Pa: WB Saunders Co; 1990:24-32. 17. Aun CST, Houghton IT, So HY, et al. Tubeless anesthesia for microlaryngeal surgery . Anesth Intensive Care . 1990;18:497-503. 18. Kennedy MG, Chinyanga HM, Steward DJ. Anaesthetic experience using a standard technique for laryngeal surgery in infants and children . Can Anaesth Soc J. 1981;28:561-566. 19. Baden JM, Rice SA. Metabolism and toxicity . In: Miller RD, ed. Anesthesia . 4th ed. New York, NY: Churchill Livingstone Ine; 1994:chap 8. 20. Martin TM, Nicolson SC, Bargas MS. Propofol anesthesia reduces emesis and airway obstruction in pediatric outpatients . Anesth Analg. 1993;76:144-148.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Feb 1, 1997

References