Laryngectomy is a time-consuming operation even in the most expert hands, making the question of anesthesia of major importance. Some operators are so fearful of the lethal effect of general anesthesia that they have gone to the extreme of doing the entire operation, including the block removal of the neck tissues, under local anesthesia. From my observations, the brutality of such a procedure is unjustifiable. I believe that the combination of both kinds of anesthesia gives us the only present solution of the problem. From the standpoint of anesthesia, the operation may be divided into three stages: (1) the skeletonization of the larynx and trachea; (2) the removal of the larynx, and (3) the closure of the wound.
The first and last of these stages may be done under novocain and the second under general anesthesia. Thus the period of sleep should not continue longer than twenty or thirty minutes.
MacKENTY JE. THE TECHNIC AND AFTER-TREATMENT OF HEMILARYNGECTOMY AND TOTAL LARYNGECTOMY. JAMA. 1917;LXIX(11):863–869. doi:10.1001/jama.1917.02590380005003
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