Anesthetic management for CO_2 laser treatment of polyp below glottis under self-retaining laryngoscope

Abstract

Objective To investigate the application of intravenous anesthesia and high frequency jet ventilation (HFJV) without intubation for ectomy of polyp below glottis with laser. Methods 42 patients (ASA Ⅰ-Ⅱ) preparing for ectomy of polyp below glottis with laser were anesthetized intravenously with remifentenal and propofol. The patients were intubated and mechanical ventilated, and then extubated immediately after suspension laryngoscope insertion. A slender metal tube (ID2.5 mm, OD3.0 mm) which top was set 5 cm below glottis was used for airway management with HFJV. The heart rate(HR), mean arterial pressure(MAP),electrocardiogram (ECG) and pulse oxygen saturation (SpO_2) were continuously monitored before induction, immediately after intubation and mechanical ventilation 5 min, immediately and after suspension laryngoscope insertion, after HFJV 1 rain, 5 rain, 10 min and 15 rain. Blood gas analysis was carried out from the dorsal artery of foot at the point of immediately after suspension laryngoscope insertion and 15 min after HFJV. Analepsia time, anesthesia time, and the operation time were recorded. Results The anesthesia time was (30.1±3.8) min and the operation time was (7.9±2.6) min. The SpO_2≥99% for all patients. The HR and the MAP were significant differences (P 0.05)compared with the point of before induction. The PaCO_2 at the point of 15 min after HFJV was increased compared with extubation (P<0.01), but lower than 70 mm Hg. Conclusion Intravenous anesthesia and HFJV without intubation is safe for the ectomy of polyp below glottis with laser. Key words: High-frequency jet ventilation; Anesthesia, Intravenous; Glottis; Polyps; Laser therapy