Anesthetic Management for Awake Tubeless Suspension Microlaryngoscopy

Abstract

Objectives/Hypothesis: Patients' eligibility for bilateral selective laryngeal reinnervation surgery is evaluated by suspension microlaryngoscopy (SML) examination with laryngeal electromyography (LEMG). Maintaining spontaneous ventilation, with remifentanil sedation/analgesia without endotracheal tube, to allow the patient to phonate with the surgeon during awake, LEMG is a major challenge for the anesthesiologist and the otorhinololaryngologist. The objective of this study was to evaluate the safety and efficacy of a novel anesthesia protocol to manage airway access during awake tubeless SML.Study Design: Retrospective study. Methods: Anesthesia records of patients undergoing awake SML with LEMG were retrospectively analyzed. Procedures were performed with remifentanil sedation/analgesia with targeted controlled infusion (TCI) in combination with local anesthesia. The main outcome was the failure rate of the anesthesia protocol during the procedure. Secondary outcomes were as follows: rate of apnea requiring ventilation, airway bleeding, regurgitation, hemodynamic data as well as vasopressor use, complications, and surgeon satisfaction with the procedure.Results: Data were obtained for 39 patients between November 2017 and September 2019, the mean age was 52 years and 29 (74%) were female. All procedures were completed without complications (0% [0-9]). Three patients (8% [1.6-20.8]) had an intraoperative episode of hypoxemia requiring mask reventilation. There was no airway bleeding, no regurgitation, and no hypotensive episode. Three patients (8% [1.6-20.8]) had noninvasive ventilation for respiratory distress after the end of the procedure.Conclusions: Our results show that awake tubeless SML allowing phonation during LEMG can be realized under sedation and local anesthesia. However, further data are needed concerning the intraoperative and postoperative safety of the procedure.

Retrospectively analyze and compare the efficacy and safety of thoracoscopic-assisted Nuss repair of pectus excavatum under intubation anesthesia and non-intubation anesthesia

“…The anesthesiologist performed the third and the fourth intercostal nerve blocks with 0.5% ropivacaine 1 mL and serratus anterior muscle blocks with 0.5% ropivacaine 20 mL under the guidance of an ultrasound probe. Propofol 10 mg/kg/h and remifentanil 0.4 μg/kg/h were pumped intravenously to maintain anesthesia, and the drug dosage was adjusted according to EEG consciousness depth and hemodynamics (18). Anesthesia induction and maintenance methods were the same for the IN group as the N-IN group, but the intercostal and serratus anterior nerve blocks were not performed in the IN group.…”

To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery

“…3,6,9 The absence of a tube may "preclude seeding the larynx and trachea with malignant cells" and even allow patients to phonate during suspension laryngoscopy. 10,11 Apneic surgeries may be supplemented with high-flow nasal cannula or transnasal humidified rapid-insufflation ventilatory exchange (THRIVE/Optiflow) to prolong apnea times. 12,13 A retrospective study of AAIV by Weisberger et al (n = 250) and a review of fully apneic surgery (n = 66) by Yoo et al, differ on contraindications to their apneic techniques.…”