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Tubeless Total Intravenous Anesthesia Spontaneous Ventilation for Adult Suspension Microlaryngoscopy.
Ann Otol Rhinol Laryngol. 2018 Jan; 127(1):39-45.AO

Abstract

INTRODUCTION

Maintaining spontaneous ventilation (SV) under total intravenous anesthesia (TIVA) without an endotracheal tube provides uninterrupted and unobstructed surgical access for suspension microlaryngoscopy (SML). This study describes the method and outcome of adults who underwent SML under tubeless TIVA-SV.

METHODS

Retrospective review of adults who underwent SML between June 2014 and September 2016 using TIVA-SV without an endotracheal tube.

RESULTS

Sixty-six cases in 36 patients were included with mean age of 50.6 years and 52.7% were female. Airway pathology included 41.6% subglottic or tracheal stenosis, 19.4% laryngeal lesion or mass, 16.7% glottic stenosis, 13.9% recurrent respiratory papilloma, and 8.3% supraglottic stenosis. Anesthesia was most commonly provided by continuous infusion of propofol and remifentanil (57.6%). Approximately half (53%) of cases received superior laryngeal nerve block. Average operative time was 72.9 minutes (range, 27-166 minutes). Eight cases required supplemental ventilation: 6 cases required transient endotracheal ventilation or mask ventilation, and 2 cases were converted to alternative ventilation.

CONCLUSIONS

Total intravenous anesthesia is an attractive alternative to traditional endotracheal tube intubation, jet ventilation, or intermittent apneic ventilation for adult SML. During episodes of hypoventilation or desaturation, endotracheal ventilation, mask ventilation, or jet ventilation can effectively recover oxygenation.

Authors+Show Affiliations

1 Department of Otolaryngology Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA.2 Department of Anesthesiology and Pain Medicine, University of Washington-Harborview Medical Center, Seattle, Washington, USA.1 Department of Otolaryngology Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29171300

Citation

Yoo, Mi Jin, et al. "Tubeless Total Intravenous Anesthesia Spontaneous Ventilation for Adult Suspension Microlaryngoscopy." The Annals of Otology, Rhinology, and Laryngology, vol. 127, no. 1, 2018, pp. 39-45.
Yoo MJ, Joffe AM, Meyer TK. Tubeless Total Intravenous Anesthesia Spontaneous Ventilation for Adult Suspension Microlaryngoscopy. Ann Otol Rhinol Laryngol. 2018;127(1):39-45.
Yoo, M. J., Joffe, A. M., & Meyer, T. K. (2018). Tubeless Total Intravenous Anesthesia Spontaneous Ventilation for Adult Suspension Microlaryngoscopy. The Annals of Otology, Rhinology, and Laryngology, 127(1), 39-45. https://doi.org/10.1177/0003489417744223
Yoo MJ, Joffe AM, Meyer TK. Tubeless Total Intravenous Anesthesia Spontaneous Ventilation for Adult Suspension Microlaryngoscopy. Ann Otol Rhinol Laryngol. 2018;127(1):39-45. PubMed PMID: 29171300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tubeless Total Intravenous Anesthesia Spontaneous Ventilation for Adult Suspension Microlaryngoscopy. AU - Yoo,Mi Jin, AU - Joffe,Aaron M, AU - Meyer,Tanya K, Y1 - 2017/11/24/ PY - 2017/11/25/pubmed PY - 2017/12/28/medline PY - 2017/11/25/entrez KW - airway KW - anesthesia KW - jet ventilation KW - laryngology KW - laryngotracheal stenosis KW - microlaryngoscopy KW - otolaryngology SP - 39 EP - 45 JF - The Annals of otology, rhinology, and laryngology JO - Ann. Otol. Rhinol. Laryngol. VL - 127 IS - 1 N2 - INTRODUCTION: Maintaining spontaneous ventilation (SV) under total intravenous anesthesia (TIVA) without an endotracheal tube provides uninterrupted and unobstructed surgical access for suspension microlaryngoscopy (SML). This study describes the method and outcome of adults who underwent SML under tubeless TIVA-SV. METHODS: Retrospective review of adults who underwent SML between June 2014 and September 2016 using TIVA-SV without an endotracheal tube. RESULTS: Sixty-six cases in 36 patients were included with mean age of 50.6 years and 52.7% were female. Airway pathology included 41.6% subglottic or tracheal stenosis, 19.4% laryngeal lesion or mass, 16.7% glottic stenosis, 13.9% recurrent respiratory papilloma, and 8.3% supraglottic stenosis. Anesthesia was most commonly provided by continuous infusion of propofol and remifentanil (57.6%). Approximately half (53%) of cases received superior laryngeal nerve block. Average operative time was 72.9 minutes (range, 27-166 minutes). Eight cases required supplemental ventilation: 6 cases required transient endotracheal ventilation or mask ventilation, and 2 cases were converted to alternative ventilation. CONCLUSIONS: Total intravenous anesthesia is an attractive alternative to traditional endotracheal tube intubation, jet ventilation, or intermittent apneic ventilation for adult SML. During episodes of hypoventilation or desaturation, endotracheal ventilation, mask ventilation, or jet ventilation can effectively recover oxygenation. SN - 1943-572X UR - https://www.unboundmedicine.com/medline/citation/29171300/Tubeless_Total_Intravenous_Anesthesia_Spontaneous_Ventilation_for_Adult_Suspension_Microlaryngoscopy_ L2 - http://journals.sagepub.com/doi/full/10.1177/0003489417744223?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -