Microlaryngoscopy-airway management with anaesthetic techniques for CO(2) laser

Carbon dioxide laser microlaryngoscopy requires planning and cooperation of both the anaesthesiologist and surgeon. While there are potentially significant complications, such as fire and difficulty ventilating the patient, laser microlaryngoscopy techniques provide the benefit of allowing for precise management of a wide range of upper airway conditions. Laryngoscopy and bronchoscopy require that the surgeon and anaesthesiologist cooperate in order to maximize exposure for the surgeon and allow for adequate ventilation of the patient. The type of airway the anaesthesiologist may use is dictated by whether access is needed to the hypopharynx, supraglottis, larynx, or subglottis. When the carbon dioxide laser is used for airway surgery, ventilation techniques that may be used include jet ventilation (subglottic or supraglottic) and intermittent or continuous endotracheal intubation, with a variety of tubes. The major complication to be avoided is airway fire. Each technique has advantages and disadvantages for avoiding fire and providing adequate ventilation. Fire is not a concern when the carbon dioxide laser bronchoscope is used, but the humidifier must be eliminated from the anaesthesia circuit to avoid vapour obstructing the bronchoscope coupler.