[Maintenance of respiratory function during direct laryngoscopy in patients with laryngeal neoplasms]

The objective of the present work was to improve the safety and control of anesthesia during diagnostic direct laryngoscopy in patients with laryngeal neoplasms. A total of 120 patients with laryngeal neoplasms underwent planned diagnostic direct laryngoscopy with partial or total tumour biopsy. The patients were allocated to three groups of 40 subjects each depending on the mode of maintenance of their respiratory function during surgery. Group 1 included patients undergoing tracheal intubation with volume-targeted artificial lung ventilation (ALV), group 2 was comprised of patients given high-frequency injection AVL through the ventilation channel of an operating laryngoscope (I HF AVL), and group 3 was constituted by patients given transdermal trans-catheter HF ALV (TC HF ALV). The patients' condition was evaluated by measuring hemodynamic parameters, pulseoxymetry, and capnometry. The majority of the patients fairly well went trough the anesthesia with adequate cardiorespiratory fitness. In 15 (12.5%) cases, volume-targeted AVL and I HF AVL during anesthesia were associated with the development of hypoxia caused by airway obstruction and the lack of adequate ventilation. Patients in the TC HF ALV group developed very few complications during anesthesia and surgical intervention that created no serious risk for their health. An algorithm of the choice of the method for the maintenance of respiratory function during direct laryngoscopy with laryngeal tumour biopsy is proposed based on the differential approach that takes into account the degree of laryngeal obstruction, anticipated difficulties of <> laryngoscopy, and indications to the use of someone or other AVL modality in individual patients.