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February 1997

Tubeless Spontaneous Respiration Technique for Pediatric Microlaryngeal Surgery

Author Affiliations

From the Department of Otolaryngology, HÔpital Sainte-Justine, Montréal University School of Medecine, Montréal, Québec (Dr Quintal), and the Departments of Otolaryngology (Dr Cunningham) and Anesthesiology (Dr Ferrari), Massachusetts Eye And Ear Infirmary, Harvard Medical School, Boston.

Arch Otolaryngol Head Neck Surg. 1997;123(2):209-214. doi:10.1001/archotol.1997.01900020097015

Background:  Tubeless spontaneous respiration technique for pediatric microlaryngeal surgery may be accomplished using different anesthetic protocols. Two methods, inhalation of volatile anesthetic agents alone and in combination with intravenous propofol, are reviewed with regard to intraoperative airway stability, post-operative morbidity, recovery room course, and halothane concentration required during maintenance anesthesia.

Design:  Retrospective case series.

Setting:  Otolaryngology referral hospital.

Patients and Methods:  Twenty-nine microlaryngeal procedures were performed using tubeless spontaneous respiration technique in children ranging from 2 weeks to 11 years of age. The following 2 anesthetic protocols were used: inhaled volatile anesthetic agents alone in 18 procedures and in combination with intravenous propofol in 11. Anesthesia, surgery, and recovery room times were documented. Specific characteristics of anesthetic maintenance, including total anesthetic gas flow (liters per minute), variations of halothane concentration (percentage), and duration of halothane administration (minutes) were also recorded to calculate the mean concentration of halothane (percentage) delivered to each patient.

Results:  No statistical differences were observed between the 2 protocols in terms of anesthesia and surgical outcomes. Adjusting for differences in patient age, weight, maintenance duration, and total anesthetic gas flow, the introduction of propofol allowed a statistically significant reduction in the mean concentration of halothane required during maintenance anesthesia.

Conclusions:  Both tubeless spontaneous respiration technique protocols proved successful in this study. However, the addition of propofol allowed a significant reduction in the halothane requirement during anesthesia maintenance. This has the potential benefit of decreasing the exposure of operating room personnel to volatile anesthetics during tubeless spontaneous respiration technique.Arch Otolaryngol Head Neck Surg. 1997;123:209-214

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