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      Inhalation Insufflation Technique with Local Anaesthetic Spray without Intubation and Opioids for Paediatric Upper Airway Surgery - Observational Case Series Study

      The Open Anesthesia Journal
      Bentham Science Publishers Ltd.

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          Abstract

          Background:

          Anaesthetic management of upper airway surgery in paediatric is challenging. Total intravenous anaesthesia with opioid or inhalation technique with spontaneous respiration has been used but studies are limited on inhalation technique. This study aimed to use tubeless inhalation insufflation technique without opioids at a tertiary centre.

          Methods:

          All paediatric patients coming for elective upper airway surgery to the centre, were included. Mask induction was with 5-8% sevoflurane in O 2 and maintenance with 2-3%, via a nasopharyngeally placed Endotracheal Tube (ETT) or catheter on spontaneous ventilation with flow between 8-10 l/min. Lidocaine up to 5 mg/kg was then sprayed to the mucosa of larynx and trachea. Once adequate depth was attained, suspension laryngoscope was placed by a surgeon for surgery. Some complications were observed i.e inadequate anaesthesia requiring rescue drugs like opioids or propofol, intubation, desaturation events from laryngospasm and delayed recovery. Surgical technique involved was diagnostic and therapeutic for the upper airway lesions.

          Results:

          Fifteen paediatric patients (2 months to 7 yrs) were included in the study with tubeless anaesthesia. None of them required intubation during the procedure. The mean time from induction of anaesthesia to unconsciousness was 15 ± 3 s and attainment of necessary anaesthetic depth for surgery was 4.7 ± 0.90 min. None had desaturation events or required opioids. However, propofol was required in one and delayed anaesthetic recovery was observed in one patient.

          Conclusion:

          This study on tubeless anaesthesia with Local Anaesthetic (LA) spray with spontaneous inhalation insufflation technique provided an opioid-free, interference-free operative field without airway compromise, not requiring intubation, therefore, further studies are required.

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          Most cited references12

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          Airway management in pediatric patients undergoing suspension laryngoscopic surgery for severe laryngeal obstruction caused by papillomatosis.

          To review perioperative airway management and ventilation strategy during the surgical removal of papilloma under suspension laryngoscopy in pediatric patients with severe airway obstruction.
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            • Article: not found

            Jet insufflation anesthesia for endolaryngeal laser surgery: a review of 318 consecutive cases.

            A series of 318 patients utilizing the jet insufflation technique for laser laryngeal anesthesia was studied. The technique utilizes a foil wrapped catheter placed below the vocal cords and attached to the Sanders ventilating adapter. Two pneumothoraces in children, one dental injury and one tube ignition were noted--all without permanent sequelae. Subsequent modification in technique prevented recurrence of these complications. The results indicate that this is a safe technique for laryngeal laser surgery, providing excellent visualization of the larynx while maintaining good oxygenation and airway control.
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              • Record: found
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              • Article: not found

              A non-tracheal intubation (tubeless) anesthetic technique with spontaneous respiration for upper airway surgery.

              The most important consideration for administration of anesthesia in upper airway surgery is maintenance of a patient's airway for optimal surgical exposure, adequate ventilation and sufficient depth of anesthesia. The tubeless anesthetic techniques, including total intravenous anesthesia with a combination of propofol and remifentanil or inhalation anesthesia with the insufflation of anesthetic gas, are considered experimental in many countries.
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                Author and article information

                Journal
                The Open Anesthesia Journal
                TOATJ
                Bentham Science Publishers Ltd.
                2589-6458
                June 30 2019
                June 30 2019
                : 13
                : 1
                : 44-46
                Article
                10.2174/2589645801913010044
                ce6b738c-bd8c-45be-9888-98a53640600e
                © 2019

                https://creativecommons.org/licenses/by/4.0/legalcode

                History

                Medicine,Chemistry,Life sciences
                Medicine, Chemistry, Life sciences

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