[A modified method of anesthesia without intubation in microsurgical treatment of the larynx]

An anaesthetic method without intubation has been used for the first time in Hungary in 107 laryngomicroscopic operations. The method includes: Vagolytic, analgetic, sedative, vasodilatator, coronary flow enhancing, antihypertensive and antitussive premedication. Administration of the sedative anaesthetic gamma-OH, void of respiratory depression, in doses of 60 mg/kg body weight (given in 2 portions), combined with diazepam, without relaxation and intubation. Supplemental analgesia and inhibition of reflexes by means of mucosal and nerve-block anaesthesia. The premedication, supplemented by endonasal nitroglycerin, reduced the increase of blood pressure, which is a characteristic feature of laryngomicroscopic operations. The combined premedication was found to be effective as well in preventing the usual cardiac arrhythmias, partly reflectory, partly due to the depression of the sinus node (sick sinus syndrome). Nevertheless, the authors emphasize the importance of continuous ECG monitoring. Operation conditions met requirements in 102 cases (intubation had to be performed in 5 patients). The method's primary field of indication includes the microsurgical manipulation of glottic synechiae, as well of lesions in the interarytenoid space or on the vocal processes. Except for the removal of bleeding papillomas, haemangiomas or cysts, the method is expedient for the microsurgical therapy of benign changes, as well as for the topical diagnosis of malignant neoplasms in other laryngeal structures. The advantages of the method are safety, maintenance of normal oxygenation, easy prevention of aspiration, as well as good visibility and photodocumentation of the free operation field, undisturbed manipulation without time limit and, last but not least, simple performance requiring no additional expensive equipment.