Ventilatory Complications of Carbon Dioxide Laser Laryngeal Surgery Kathryn Cozine, MD,* J. Gilbert Stone, MD,? Steven Shulman, MD,$ Edith R. Flaster, MS@ Department of Anesthesiology and Irving Center for Clinical Research, College of Physicians and Surgeons, Columbia University, New York, NY.

*Assistant Professor, Anesthesiology

Department

of

TAssociate Professor, Anesthesiology

Department

of

*Fellow, Department of Anesthesiology &Statistician, Irving Research

Center

for

Clinical

Presented at the October 1989 meeting of the American Society of Anesthesiologists in New Orleans. Address reprint requests to Dr. Cozine at the Department of Anesthesiology, Columbia Presbyterian Medical Center, 177 Fort Washington Avenue, New York, NY 10032, USA. Received for publication January 12, 1990; revised manuscript accepted for publication June 19, 1990. 0 1991 Butterworth-Heinemann

20

J. Clin. Anesth.,

Study Objective: To evaluate complications associated with ventilatory techniques accompanying endolaryngeal carbon dioxide laser surgery. Design: Retrospective survey of the Society of Academic Anesthesia Chairmen. Setting: Operating room at an urban medical center. Patients: Data from 15,701 patients were analyzed. Measurements and Main Results: Twenty-six percent of patients were ventilated with Venturi jet ventilation and the rest through an endotracheal tube. Reported complications were classified as ventilation related and ventilation unrelated, as well as by severity. A total of 49 complications occurred in the Venturi jet group (1.2%). Of these complications, 24 were ventilation related (0.58%) and 18 were serious or life threatening (0.43 %). There were no deaths in this group. Ventilation through an endotracheal tube was associated with a lower frequency of overall complications (0.36%), ventilation-related complications (0.15%), serious or lafethreatening complications (0.15%), and serious or life-threatening ventilationrelated complications (0.11%) (p < 0.001). However, there were eight airway fires in this latter group, one resulting in a ,fatality. Conclusions: No clear choice of ventilatory technique is supported by this .survey, but teamwork and experience Lg-ivethe best results. Keywords: Anesthesia, intratracheal; surgery; larynx; pneumomediastinum;

intubation, intratracheal; laser pneumothorax; ventilation.

Introduction The carbon dioxide (CO,) laser provides surgical precision and minimizes tissue trauma and bleeding.’ Anesthetic management for endoscopic CO, laser surgery of the larynx must allow adequate exposure of the surgical field, ensure satisfactory respiratory gas exchange, and prevent airway fires.‘-5 The two commonly used ventilatory techniques are quite differ-

vol. 3, January/February

1991

Laser surgery ventilatory complications:

ent. The first uses ventilation through an endotracheal tube, and the second uses Venturi jet ventilation.3,5-7 Each technique has advantages and disadvantages. Complications have been reported with both techniques, ‘-I3 but the frequency of such complications is unknown. This retrospective nationwide survey was undertaken to determine the frequency of ventilatory techniques used during CO, laser laryngeal surgery and to determine the frequency of their associated complications.

Cozine et al.

most of which used this method since the early 1980s. Of these 58 institutions, 30 did not use Venturi jet ventilation and 28 used both Venturi jet ventilation and standard ventilation through an endotracheal tube. Survey data from 15,701 patients who underwent CO, laser endoscopic laryngeal surgery were analyzed and tabulated. A total of 4,151 patients (26%) received Venturi jet ventilation, and 11,550 patients received ventilation through an endotracheal tube. Forty-nine complications of 13 different varieties occurred in the Venturi jet group (Table 1). There were 14 instances of barotrauma (9 pneumothoraces, I),

Materials and Methods Surveys sentout to 109 institutions.

A questionnaire (see Appendix) was sent to the 109 members of the Society of Academic Anesthesia Chairmen, Inc., requesting specific information regarding the number of CO, laser laryngeal procedures done, the type of ventilation used in each case, and the complications

encountered.

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Ventilatory complications of carbon dioxide laser laryngeal surgery.

To evaluate complications associated with ventilatory techniques accompanying endolaryngeal carbon dioxide laser surgery...
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