XI General Anesthesia for Total Laryngectomy

Abstract

Several years ago I witnessed two total laryngectomies done under local anesthesia. It seemed that these patients suffered undue pain, psychic shock, as well as a moderate degree of hypoxia. The hypoxia was due to laryngeal obstruction in the early stages of the operation and to collections of blood and to coughing spasms in the later stages of the operation.Recently I have had occasion to administer anesthesia for four total laryngectomies. With the cooperation of the surgeon a technic was devised whereby the operation was done under general anesthesia, eliminating the undesirable features mentioned above.Routine pre-anesthetic sedation was employed in all cases where respiratory obstruction was not severe. This consisted of pentobarbital gr. 1~the night before operation and a moderate dose of morphine and atropine (or scopolamine) 1~hours pre-operatively. If severe obstruction was present, little or no sedation was used.These patients were anesthetized with nitrous-oxide-oxygen-ether and an ordinary MacGill endotracheal tube inserted. The nasal route is preferred because then it is not necessary to prop the mouth partially open. This allows more room for the surgeon when the head is extended. The gas machine was connected to the endotracheal tube, the head extended, and the operation started (Fig. 1).The surgeon skeletonized the larynx and upper end of the trachea easily because he could retract these structures from side to side at will with no respiratory obstruction. When this was complered the trachea or lower end of the larynx was opened at the elected site of severance. Under direct vision the anesthetist then withdrew the endotracheal tube sufficiently so that the severances of the trachea could be completed. The cut end of the trachea was grasped with an Allis forceps and brought up into the incision in the neck. The MacGill tube was withdrawn from the larynx. A sterile anode This work was done with the cooperation and assistance of the