Endotracheal intubation and Venturi (jet) ventilation for laser microsurgery of the larynx. 1976

M L Norton, and M S Strong, and C W Vaughan, and J C Snow, and B J Kripke

Meeting the exacting requirements for microsurgery of the larynx is a challenge for the anesthesiologist. To accomplish, the necessary dissection, the otolaryngologist has several requirements. They are a quiet relaxed field, excellent illumination with magnification, binocular vision for depth perception, and, above all, an unobstructed field. The management of anesthesia for suspension microsurgery on the larynx presents many problems, the most vexing of which is the fact that the otolaryngologist and anesthesiologist are in competition for access to the patient's airway. In sharing this, neither has been able to perform with the degree of control that he would like due to either inadequate operating conditions or insufficient access to ventilatory mechanisms. Several anesthetic techniques have been used for inspection or operative laryngoscopy: topical anesthesia, apneic techniques, translaryngeal topical anesthesia, chest respirator, neuroleptanalgesia, and general endotracheal anesthesia with muscle relaxants. The latter has proven most popular, particularly in children, because ventilation and surgical conditions are considered to be most controllable. However, the presence of the requisite endotracheal tube obscures the full view of the larynx and vocal cords, and the tube may itself become obstructed. Additionally, use of the laser involves the further risk of heat effects on the endotracheal tube if the beam hits the tube. This report presents our experience and development of the combined technique of endotracheal intubation and Venturi (jet) ventilation. We believe it represents the safest available approach while providing near ideal working conditions for the otolaryngologist during laser microsurgery of the larynx.

UI MeSH Term Description Entries
D007442 Intubation, Intratracheal A procedure involving placement of a tube into the trachea through the mouth or nose in order to provide a patient with oxygen and anesthesia. Intubation, Endotracheal,Endotracheal Intubation,Endotracheal Intubations,Intratracheal Intubation,Intratracheal Intubations,Intubations, Endotracheal,Intubations, Intratracheal
D007818 Laryngeal Diseases Pathological processes involving any part of the LARYNX which coordinates many functions such as voice production, breathing, swallowing, and coughing. Laryngeal Perichondritis,Larynx Diseases,Disease, Laryngeal,Disease, Larynx,Diseases, Laryngeal,Diseases, Larynx,Laryngeal Disease,Laryngeal Perichondritides,Larynx Disease,Perichondritides, Laryngeal,Perichondritis, Laryngeal
D007834 Lasers An optical source that emits photons in a coherent beam. Light Amplification by Stimulated Emission of Radiation (LASER) is brought about using devices that transform light of varying frequencies into a single intense, nearly nondivergent beam of monochromatic radiation. Lasers operate in the infrared, visible, ultraviolet, or X-ray regions of the spectrum. Masers,Continuous Wave Lasers,Pulsed Lasers,Q-Switched Lasers,Continuous Wave Laser,Laser,Laser, Continuous Wave,Laser, Pulsed,Laser, Q-Switched,Lasers, Continuous Wave,Lasers, Pulsed,Lasers, Q-Switched,Maser,Pulsed Laser,Q Switched Lasers,Q-Switched Laser
D008297 Male Males
D008478 Mediastinal Emphysema Presence of air in the mediastinal tissues due to leakage of air from the tracheobronchial tree, usually as a result of trauma. Emphysema, Mediastinal,Interstitial Emphysema,Interstitial Emphysema of Lung,Pneumomediastinum,Pulmonary Interstitial Emphysema,Emphysema, Interstitial,Emphysema, Pulmonary Interstitial,Emphysemas, Pulmonary Interstitial,Interstitial Emphysema, Pulmonary,Interstitial Emphysemas, Pulmonary,Lung Interstitial Emphysema,Mediastinal Emphysemas,Pneumomediastinums,Pulmonary Interstitial Emphysemas
D008866 Microsurgery The performance of surgical procedures with the aid of a microscope.
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009068 Movement The act, process, or result of passing from one place or position to another. It differs from LOCOMOTION in that locomotion is restricted to the passing of the whole body from one place to another, while movement encompasses both locomotion but also a change of the position of the whole body or any of its parts. Movement may be used with reference to humans, vertebrate and invertebrate animals, and microorganisms. Differentiate also from MOTOR ACTIVITY, movement associated with behavior. Movements
D011030 Pneumothorax An accumulation of air or gas in the PLEURAL CAVITY, which may occur spontaneously or as a result of trauma or a pathological process. The gas may also be introduced deliberately during PNEUMOTHORAX, ARTIFICIAL. Pneumothorax, Primary Spontaneous,Pressure Pneumothorax,Primary Spontaneous Pneumothorax,Spontaneous Pneumothorax,Tension Pneumothorax,Pneumothorax, Pressure,Pneumothorax, Spontaneous,Pneumothorax, Tension,Spontaneous Pneumothorax, Primary
D011175 Positive-Pressure Respiration A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange. Positive End-Expiratory Pressure,Positive-Pressure Ventilation,End-Expiratory Pressure, Positive,End-Expiratory Pressures, Positive,Positive End Expiratory Pressure,Positive End-Expiratory Pressures,Positive Pressure Respiration,Positive Pressure Ventilation,Positive-Pressure Respirations,Positive-Pressure Ventilations,Pressure, Positive End-Expiratory,Pressures, Positive End-Expiratory,Respiration, Positive-Pressure,Respirations, Positive-Pressure,Ventilation, Positive-Pressure,Ventilations, Positive-Pressure

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