A modified technique of tubeless anaesthesia for microlaryngoscopy and bronchoscopy in young children with stridor

Abstract

Sixty children including neonates and infants, with stridor undergoing investigations under general anaesthesia, were studied retrospectively. General anaesthesia was induced using an inhalational technique with halothane and was maintained with propofol infusion without the use of tracheal intubation. The ages ranged from three days to two years and five months. In most of the cases after propofol infusion, there was a slight drop in blood pressure without change in heart rate. This modified technique was found to be satisfactory in most of the cases.

Combination propofol–ketamine anaesthesia in sick neonates

“…Although experience is limited, propofol infusions have been used safely as a component of the anaesthetic regimen for various neonatal surgical procedures ( 2–4). Gin et al .…”

Tubeless anaesthesia with sevoflurane and propofol in adult laryngeal surgery

“…Primary end point was to maintain adequate level of anaesthesia as measured with the bispectral index (BIS < 60). Secondary end points were: (1) to maintain the patient's oxygen saturation over 90%; (2) to avoid disturbing patient movement during the operation; and (3) to preserve the measured haemodynamic parameters (systolic, mean and diastolic blood pressure, heart rate) within §30% of the baseline values. Deviations from end point goals were managed primarily by adjusting the sevoXurane vaporiser using its whole range (0-8.0 vol%) and secondarily by injecting 20-50 mg boluses of propofol when indicated.…”

“…In most cases, the use of a small-diameter endotracheal tube or jet ventilation cannula is acceptable, but sometimes a completely free view is needed. Several modiWcations of tubeless anaesthesia techniques have been introduced for diVerent purposes in both adult and paediatric cases [1][2][3][4]. Basically, all these methods aim to preserve spontaneous breathing, and anaesthesia maintenance is carried out by using either volatile agents insuZated to the upper airways, intravenous anaesthesia or a combination of both these techniques.…”

“…Basically, all these methods aim to preserve spontaneous breathing, and anaesthesia maintenance is carried out by using either volatile agents insuZated to the upper airways, intravenous anaesthesia or a combination of both these techniques. The most commonly used agents for this purpose have been halothane [4,5], sevoXurane [6] and propofol, given as a continuous infusion [2] or repeated boluses [1].…”

“…The adequacy of the anaesthesia was estimated by bispectral index (BIS), haemodynamic responses, peripheral oxygen saturation (SaO 2 ) and subjective assessment with 100 mm VAS scale by the operating ENT surgeon and the two attending anaesthesiologists. Other aims of the study were to: (1) measure the sevoXurane contamination in the operating theatre caused by the use of this completely open anaesthesia system; (2) describe in detail the method we use.…”