Modified tubeless anesthesia during endoscopy for assessment of head and neck cancers

We evaluated a modified technique of administering anesthesia without a tube and with spontaneous respiration during video-assisted tele-laryngo-tracheo-broncho-endoscopy (TLTBE). The endoscopy was performed as an alternative to rigid ventilatory bronchoscopy during screening for synchronous tumors in the tracheobronchial tree in patients who had head and neck malignancies. Thirty consecutive patients who required diagnostic panendoscopy were selected for this study. During direct-suspension laryngoscopy, anesthesia was delivered by administering intravenous bolus injections of propofol at 0.5 to 2 mg/kg every 5 to 10 minutes. A good view of the larynx, trachea, and main bronchi was obtained with a 50-cm 0 degree telescope, which caused no obstruction of the airway. During laryngoscopy, arterial oxygen saturation levels, pulse rates, and blood pressures were stable in all patients. No apnea was associated with the use of propofol during any procedure, and we observed no intraoperative or postoperative complication in any patient. Video-assisted TLTBE is appropriate for patients with a grade 1 or 2 larynx, good cardiopulmonary function, and no significant airway obstruction. It is a safe and time-saving alternative to rigid ventilatory bronchoscopy for staging primary tumors and for screening for synchronous tumors in the respiratory tract.