Peroral operations in and about the larynx, such as taking of biopsy specimens or removal of polypi, cysts, and the like through the laryngoscope, are associated with special anesthetic problems, because oral intubation cannot be applied and accordingly the patient's respiration cannot be controlled in the usual way. The ordinary technique of anesthesia is therefore based on preservation of the patient's spontaneous respiration.
In adults surface analgesia generally fulfills this requirement. It can make the surgical procedure tolerable in many cases, but does not provide ideal operating conditions, as especially nervous patients cannot voluntarily relax the cervical and mandibular muscles. In addition, a necessary immobilization of the vocal cords cannot be secured, even under carefully induced surface analgesia.
In a previously-reported investigation1 meperidine (Demerol, isonipecaine, Dolantin, pethidine), injected intravenously, was found to have a depressing effect on the laryngeal and pharyngeal reflexes. This effect was utilized for anesthetization prior
KNUDSEN EJ, RASMUSSEN H, RUBEN H, TRAUN-PEDERSEN P. Techniques of Anesthesia and Laryngoscopy in Peroral Laryngeal Operations. AMA Arch Otolaryngol. 1958;67(1):20–23. doi:10.1001/archotol.1958.00730010024004
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