Apneic anesthesia for improved endoscopic removal of laryngeal papillomata

During a 2-year period at Indiana University Medical Center, nine patients underwent 51 endoscopic procedures employing the technique of apneic anesthesia for removal of papillomata involving the larynx. The apneic anesthesia technique affords improved visualization of the larynx and subglottis because the view is unencumbered by an endotracheal tube. This unencumbered view allows a more thorough removal of diseased tissue, especially in the posterior commissure and subglottis. In addition, the absence of an endotracheal tube reduces the risk of a fire occurring in the upper airway and eliminates the chance of physically disseminating papilloma particles into the lower tracheal-bronchial tree or toward the physician--a problem that is inherent in the intermittent jet ventilation technique. No significant complications related to the use of this technique have been encountered; however, the safety of apneic anesthesia is greatly enhanced by using a pulse oximeter and transcutaneous oxygen monitor to continuously monitor arterial oxygen saturation. Details of the apneic anesthesia technique are described, as are the relevant aspects of pulmonary physiology, which must be clearly understood to safely employ this method.