Anesthetic Management for Tracheobronchial Laser Surgery

Abstract

The use of the laser has become a well-recognized means of treating obstructing lesions of the tracheobronchial tree. Patients with lower airway compromise are in a precarious state of equilibrium. Everything done by the endoscopy-anesthesiology team tends to change this balance. Cooperation and coordination of this well-disciplined team is needed for efficient treatment of difficult cases. This paper outlines our surgical techniques, which have been tempered and modified to an anesthetic technique that provides the greatest safety with comfort. We detail the basic anesthetic methods for drug usage, pulmonary ventilation, and patient monitoring that we now use. A careful analysis of our results is presented to show that this technique does provide relatively safe anesthesia in this difficult setting.

Laser Bronchoscopy in Palliative Treatment of Malignant Obstructing Endobronchial Tumors

“…This was the case also in our patients. When deciding whether or not to give laser therapy, one must take into account that these procedures involve the possibility of fatal complications [5]. The most usual complications are intraoperative bleeding and difficulties in maintaining adequate ventilation.…”

“…Both local and general anesthesia have been recommended as the method of choice but also different ventilation techniques to provide adequate ventilation have been suggested. We chose general anesthesia and jet ventilation but also local anesthesia has been successfully used in patients with malignant disease [5]. If possible, the sufficiency of ventilation should be verified with end-tidal CO 2 monitoring.…”

What Is the Safest Endotracheal Tube for Nd-YAG Laser Surgery????A Comparative Study

“…Dumon et al (9) recommend the use of a rigid bronchoscope instead of an endotracheal tube for Nd-YAG laser surgery of the tracheobronchial tree. Rontal et al (10) suggest that when peripheral lung lesions are to be treated, a fiber-optic bronchoscope should be passed through a rigid bronchoscope rather than through an endotracheal tube.…”

The Physics of Lasers and Implications for Their Use During Airway Surgery

“…S= 6 mm) can be passed nasotracheally in the awake patient, via a tracheal tube (i.d. 5= 8 mm) with swivel or membrane connector during general anaesthesia or via the rigid bronchoscope during either local or general anaesthesia [9,17,44,68]. Flexible fibreoptic bronchoscopy is well suited for the preoperative assessment of the pulmonary pathology; local anaesthesia for the nasotracheal passage of the fibrescope is accomplished easily by the use of lignocaine applied through a nasal spray and an ultrasonic nebulizer.…”