Tubeless anaesthesia with sevoflurane and propofol in adult laryngeal surgery

Abstract

The presence of endotracheal intubation tube or jet ventilation cannula can compromise free view and access to operation area in certain endolaryngeal operations. The objective of this prospective study was to test whether adequate level of anaesthesia could be obtained in adults using tubeless sevoflurane inhalation anaesthesia with spontaneous breathing. In 23 ASA 1-2 patients, 31 treatments were included in the study of which 19 were laser-assisted papilloma or other tumour resections and 12 were fascia injection laryngoplasties. Anaesthesia was induced with propofol and maintained by insufflating sevoflurane mixture to the patient's oropharynx. The adequacy of the anaesthesia level was assessed by monitoring bispectral index, haemodynamic parameters and peripheral oxygen saturation during the anaesthesia. The ENT surgeon estimated operating conditions, whilst the two participating anaesthesiologists assessed the quality of anaesthesia using a 100 mm VAS scale. Sevoflurane contamination in the operating theatre was measured during five treatments. Mean bispectral index was below 40 throughout the operation. Haemodynamic parameters showed only minor changes during the anaesthesia. Both attending anaesthesiologists and operating ENT surgeon were satisfied with the quality of the anaesthesia and operating conditions (VAS 83 ± 15, mean ± SD, range 42-100, and VAS 93 ± 10, range 55-100, respectively). Sevoflurane room air contamination was high in most measured cases. The modification of tubeless inhalation anaesthesia used in this study produced adequate level of anaesthesia with stable haemodynamics and good operating conditions. Sevoflurane contamination can be reduced with more efficient scavenging systems.

Superior Laryngeal Nerve Block for Microlaryngoscopic Surgery: A Systematic Review and Meta‐Analysis

“…[25][26][27] In addition, various drugs have been used to suppress the cardiovascular response of MLS, including intravenous infusion drugs (including propofol, dexmedetomidine, lidocaine, β-blockers or esketamine), inhalation sevoflurane, and oral drugs (such as clonidine and gabapentin). 17,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] However, propofol could delay anesthesia recovery, β-blockers could increase perioperative cardiac complications, and oral administration has a slow onset of action. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Therefore, the efficacy of these techniques seems to be unreliable based on the variable outcomes.…”

“…17,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] However, propofol could delay anesthesia recovery, β-blockers could increase perioperative cardiac complications, and oral administration has a slow onset of action. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Therefore, the efficacy of these techniques seems to be unreliable based on the variable outcomes.…”

“…Different topical anesthetic techniques have been used to suppress the perioperative stress response of MLS, including aerosolized lidocaine before or after suspension laryngoscopy and sprayed lidocaine to the laryngeal mucosa 25–27 . In addition, various drugs have been used to suppress the cardiovascular response of MLS, including intravenous infusion drugs (including propofol, dexmedetomidine, lidocaine, β‐blockers or esketamine), inhalation sevoflurane, and oral drugs (such as clonidine and gabapentin) 17,28–41 . However, propofol could delay anesthesia recovery, β‐blockers could increase perioperative cardiac complications, and oral administration has a slow onset of action 28–41 .…”

Anesthetic Challenges During Laser Surgery of the Larynx Part 2. Operating Room Fire

“…International Bulletin of Otorhinolaryngology 3 / 2019 flurane and spontaneous ventilation 24 ; however, volatile anesthetics are not reliably delivered to the patient if jet ventilation is required, and the vapors can pollute the OR. Finally, although the volatile anesthetics currently used in clinical practice are nonflammable and nonexplosive in clinically relevant concentrations, 25 when exposed to flame, they may pyrolyse to potentially toxic compounds.…”