Feasibility of standard mechanical ventilation with low FiO2 and small endotracheal tubes during laser microlaryngeal surgery
✍ Scribed by Elisa Nicelli; Marco Gemma; Assunta De Vitis; Giuseppe Foti; Luigi Beretta
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 108 KB
- Volume
- 32
- Category
- Article
- ISSN
- 1043-3074
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
Background.
No technique can be considered as a gold standard for ventilation during direct laser CO~2~ laryngeal microsurgery. We evaluated the feasibility of standard ventilation with laser‐safe endotracheal tubes (ETTs) and inspired O~2~ fraction (FiO~2~) = 0.21 during direct microlaryngoscopy.
Methods.
During total intravenous anesthesia, standard mechanical normoventilation was set with FiO~2~ = 0.21 and 50 mm Hg peak inspiratory pressure limit. If SpO~2~ was <90% for >2 minutes, FiO~2~ was increased to 0.3; after 4 minutes it was increased to 0.4; after another 4 minutes, positive end‐expiratory pressure (PEEP) could be set at 5 cm H~2~O; and after another 4 minutes, surgery was stopped if SpO~2~ remained <90%.
Results.
We studied 111 consecutive direct microlaryngoscopies on different patients. Four patients (3.6%) suffered minor intraoperative desaturation. Barotrauma was not observed, PEEP was never applied, and surgery was never stopped. Body mass index was independently predictive of the occurrence of intraoperative desaturation.
Conclusions.
Standard mechanical ventilation with FiO~2~ = 0.21 through laser‐safe ETTs is feasible during direct microlaryngoscopy. © 2009 Wiley Periodicals, Inc. Head Neck, 2010