Anesthesia for laser surgery of the airway in children

Abstract

SummaryAnesthesia for laser surgery in children carries a number of particular challenges and pitfalls. The anesthetist must be aware not only of the problems of anesthetizing a patient with a potentially compromised airway but also of how to maintain homeostasis when surgery is taking place, as procedures may make a bad situation temporarily worse. Personnel must also be very aware of the benefits and dangers of medical lasers, and what safety precautions must be taken to ensure their proper use. This section will deal with the properties of lasers, how and why they are used, and a description of how these procedures are carried out in our own institution.

"Blow-torch phenomenon" during laser assisted excision of a thyroglossal cyst at the base of the tongue

“…To reduce the obstruction in the surgical field, by airway instruments, even techniques of spontaneous ventilation or intermittent apnea with intravenous anesthetics have been used. [6] Clear communication must be ensured and protocols followed to manage and avert such crisis.…”

Anesthesia for shared airway surgery in children

“…Laser‐safe tubes are made from rubber, silicone, or reinforced with stainless steel. Their cuffs are usually filled with saline, which may be dyed blue to allow immediate detection of a puncture …”

“…The endotracheal tube provides a secure airway critical for patients with cardiovascular instability, severe respiratory insufficiency, significant gastric reflux, airway bleeding, or obstructive airway lesions. The presence of the endotracheal tube can hinder the view of the surgical field and poses a small but significant airway fire risk if used with a laser . For patients with specific characteristics such as those delineated above, there is often little choice.…”

Technical description of a modified jet ventilation injector for airway laser surgery in neonates and infants: retrospective analysis of 20 cases

“…The third is standard ventilation with a laser-compatible endotracheal tube, but it limits the surgeon's vision of the larynx. Moreover, tube size for small infants remains an issue [2,3]. Last, jet ventilation (JV) provides excellent surgical conditions but is not commonly used in infants.…”

“…There are several different ventilation techniques that can be used for that purpose. The first is spontaneous ventilation without tracheal intubation, which avoids altogether a source of combustible material and restriction of the surgeon's view [2]. However, the vocal cords are not immobile, and there is concern regarding respiratory depression and laser fumes inhalation.…”