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A non-tracheal intubation (tubeless) anesthetic technique with spontaneous respiration for upper airway surgery.
Clin Invest Med. 2013 Jun 01; 36(3):E151-7.CI

Abstract

BACKGROUND

The most important consideration for administration of anesthesia in upper airway surgery is maintenance of a patient's airway for optimal surgical exposure, adequate ventilation and sufficient depth of anesthesia. The tubeless anesthetic techniques, including total intravenous anesthesia with a combination of propofol and remifentanil or inhalation anesthesia with the insufflation of anesthetic gas, are considered experimental in many countries.

METHODS

Fifteen pediatric (8 to 60 months) and 16 adult (23 to 55 years) patients were included in the study. Anesthesia (gas insufflation) was induced into the pediatric patients by inhalation of 8% sevoflurane in 8 L/min oxygen flow. An endotracheal tube, inserted through the nasal or oral cavity with its tip in the laryngopharynx, was used to maintain anesthesia with 3%-6% sevoflurane in 4 L/min oxygen flow. Total intravenous anesthesia was induced in adult patients by inhalation, 8% sevoflurane in 8 L/min oxygen flow, combined with intravenous injections of propofol (1.5-2 mg/kg) and fentanyl (1.5-2 μg/kg). Assisted ventilation was maintained by use of a face or laryngeal mask. Propofol infusion at 200-300 μg/kg/min, combined with remifentanil infusion at 0.06-0.2 μg/kg/min, was used for maintaining anesthesia.

RESULTS

All patients had surgery under tubeless anesthesia with steady spontaneous respiration. The mean time from induction of anesthesia to unconsciousness was 16±3 s and 36±14 s in pediatric and adult groups, respectively. The average times from induction of anesthesia to the attainment of necessary anesthetic level for surgery while keeping steady spontaneous respiration was 4.17±0.96 min and 8.69±3.17 min in pediatric and adult groups, respectively. The frequency and extent of respiration and heart rate were maintained within the normal range; SpO2 was > 98%. None of the patients developed complications.

CONCLUSION

Tubeless anesthesia with spontaneous ventilation induced in patients can provide both an interference-free operative field and continuous observation of airway activity, which may provide an effective approach in excellent surgical conditions for the actual airway operation.

Authors+Show Affiliations

Department of Anesthesiology, Eye Ear Nose and roat Hospital, Fudan University, Shanghai 200031, China.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

23739669

Citation

Xu, Jing, et al. "A Non-tracheal Intubation (tubeless) Anesthetic Technique With Spontaneous Respiration for Upper Airway Surgery." Clinical and Investigative Medicine. Medecine Clinique Et Experimentale, vol. 36, no. 3, 2013, pp. E151-7.
Xu J, Yao Z, Li S, et al. A non-tracheal intubation (tubeless) anesthetic technique with spontaneous respiration for upper airway surgery. Clin Invest Med. 2013;36(3):E151-7.
Xu, J., Yao, Z., Li, S., & Chen, L. (2013). A non-tracheal intubation (tubeless) anesthetic technique with spontaneous respiration for upper airway surgery. Clinical and Investigative Medicine. Medecine Clinique Et Experimentale, 36(3), E151-7.
Xu J, et al. A Non-tracheal Intubation (tubeless) Anesthetic Technique With Spontaneous Respiration for Upper Airway Surgery. Clin Invest Med. 2013 Jun 1;36(3):E151-7. PubMed PMID: 23739669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A non-tracheal intubation (tubeless) anesthetic technique with spontaneous respiration for upper airway surgery. AU - Xu,Jing, AU - Yao,Zheng, AU - Li,Shaoqing, AU - Chen,Lianhua, Y1 - 2013/06/01/ PY - 2013/06/05/received PY - 2013/6/7/entrez PY - 2013/6/7/pubmed PY - 2014/1/1/medline SP - E151 EP - 7 JF - Clinical and investigative medicine. Medecine clinique et experimentale JO - Clin Invest Med VL - 36 IS - 3 N2 - BACKGROUND: The most important consideration for administration of anesthesia in upper airway surgery is maintenance of a patient's airway for optimal surgical exposure, adequate ventilation and sufficient depth of anesthesia. The tubeless anesthetic techniques, including total intravenous anesthesia with a combination of propofol and remifentanil or inhalation anesthesia with the insufflation of anesthetic gas, are considered experimental in many countries. METHODS: Fifteen pediatric (8 to 60 months) and 16 adult (23 to 55 years) patients were included in the study. Anesthesia (gas insufflation) was induced into the pediatric patients by inhalation of 8% sevoflurane in 8 L/min oxygen flow. An endotracheal tube, inserted through the nasal or oral cavity with its tip in the laryngopharynx, was used to maintain anesthesia with 3%-6% sevoflurane in 4 L/min oxygen flow. Total intravenous anesthesia was induced in adult patients by inhalation, 8% sevoflurane in 8 L/min oxygen flow, combined with intravenous injections of propofol (1.5-2 mg/kg) and fentanyl (1.5-2 μg/kg). Assisted ventilation was maintained by use of a face or laryngeal mask. Propofol infusion at 200-300 μg/kg/min, combined with remifentanil infusion at 0.06-0.2 μg/kg/min, was used for maintaining anesthesia. RESULTS: All patients had surgery under tubeless anesthesia with steady spontaneous respiration. The mean time from induction of anesthesia to unconsciousness was 16±3 s and 36±14 s in pediatric and adult groups, respectively. The average times from induction of anesthesia to the attainment of necessary anesthetic level for surgery while keeping steady spontaneous respiration was 4.17±0.96 min and 8.69±3.17 min in pediatric and adult groups, respectively. The frequency and extent of respiration and heart rate were maintained within the normal range; SpO2 was > 98%. None of the patients developed complications. CONCLUSION: Tubeless anesthesia with spontaneous ventilation induced in patients can provide both an interference-free operative field and continuous observation of airway activity, which may provide an effective approach in excellent surgical conditions for the actual airway operation. SN - 1488-2353 UR - https://www.unboundmedicine.com/medline/citation/23739669/A_non_tracheal_intubation__tubeless__anesthetic_technique_with_spontaneous_respiration_for_upper_airway_surgery_ L2 - https://medlineplus.gov/anesthesia.html DB - PRIME DP - Unbound Medicine ER -