Smita R, Digant B Jansari, Neha Yadav
ABSTRACT
Introduction: Laser surgery poses critical challenges to the anaesthesiologist which is compounded further by the different indications for laser surgery. Problems include the conflicting needs of the surgeon and the anaesthesiologist for access of the airway, fire hazards associated with the laser beams, the absolute necessity to ensure the adequacy of ventilation and the intense cardiovascular presser response. Every conceivable mode of airway management and ventilation has been used for laser surgery of the airway.1,2,3,4
Aim: To highlight various methods of airway control, to evaluate intra-operative hemodynamic changes and any complications.
Material and method: Thirty five patients of both sexes and all age groups posted for surgeries of an airway (nose, oral cavity, larynx, trachea and bronchus) have been included. In all the patients ventilation was performed with an air / oxygen mixture and total intravenous anaesthesia at the time of laser ablation. The patients were ventilated by side arm of a ventilating bronchoscope or laser endo-tracheal tube using IPPV or LFJV.
Results: Adequate oxygenation and ventilation was achieved in all patients. The changes in SpO2, EtCO2 & hemodynamic variables were significantly less in surgery for nasal, oral, palatal and laryngo-tracheal surgeries of short duration. No complications including airway fire, major haemorrhage, or aspiration of debris secondary to the ventilation technique were observed. Barotrauma occurred in one patient for bronchial laser ablation and required ICD and postoperative mechanical ventilation.
Conclusion: LFJV is a better mode of ventilation for laryngo-tracheal surgeries of short duration. It is preferable for laser surgeries.
Keywords: airway lasers, endoscopy, airway surgery, Jet ventilation, Safety measures