Intravenous anesthesia and jet ventilation for laser microlaryngeal surgery

Competition between otolaryngologists and anesthesiologists for the limited space of the airway results in compromised control for both concerns. The surgeon desires an unobstructed view, whereas the anesthesiologist must ensure adequate ventilation. The drawbacks of standard methods include inadequate airways, inadequate visualization, and operating room contamination from inspired gases. Since 1984, we have developed a technique utilizing jet ventilation delivered through a metal delivery system providing a relatively safe, ignition-free environment. A total intravenous anesthetic technique is used to avoid any environmental contamination. The newer short acting, high potency narcotic, sufentanil citrate, combined with a short acting muscle relaxant, atracurium besylate or vecuronium bromide, have made this technique an ideal one for our needs. The pulse oximeter provides an invaluable margin of safety. This technique has been employed in 36 microlaryngeal procedures performed on 21 patients with a uniformly smooth perioperative course and only one complication. The technique, possible pitfalls, and applications are discussed.