Hemodynamic Complications During Laser Surgery of the Larynx

Abstract

Introduction: Laser surgery of the larynx offers several advantages over conventional surgical methods, including a bloodless operative field and microscopic precision. However, the anesthetist faces special issues in the management of these patients. The Aim of the study is to determine the hemodynamic complications during laser surgery of the larynx. Materials and Methods: A 2-year prospective cohort study of 50 patients who underwent laser microsurgery of the larynx in the Department of ENT Surgery; University Hospital „Queen Giovanna”- ISUL; Medical University-Sofia. We used total IV anesthesia. All patients were monitored and recorded for: Peripheral Capillary Oxygen Saturation (SpO2); Systolic blood pressure (SBP), Diastolic blood pressure (DBP); heart rate (HR); continuous electrocardiography (ECG). Results and discussion: The mean age of the patients is 61.04 years. 8% of them are females and 92% are males. According to anesthesia risk assessment 4% of the patients are with ASA 1 class, 30% of them are with ASA 2 class, 64% are with ASA 3 class and 2% are with ASA 4 class. The mean duration of operation is 57.06 minutes. Mean systolic blood pressure of the patients is 141.22 mmHg, mean diastolic blood pressure is 86.2 mmHg and mean pulse rate is 60.94 beats per minute. 44% of the patients have arterial hypertension I grade, 24% of them are with isolated arterial hypertension and 32% are with normal blood pressure. 44% of the patients had pulse rate between 45-60 beats per minute during putting on the tube of Kleinsasser, 32% of them had pulse rate>60 beats per minute during putting on the tube of Kleinsasser and 28% had pulse rate<45 beats per minute during putting on the tube of Kleinsasser. Conclusion: Laser surgery of the larynx is specific kind of surgery which is characterized by hypertensive hemodynamic. There is a risk of severe bradycardia after putting on the tube of Kleinsasser which can cause hemodynamic instability and even cardiac arrest if not corrected immediately.