(Dr.Thomas, the Senior Anesthetist in Jubilee Hospital, Trivandrum, explains the techniques and issues in giving GA for this patient undergoing micro laryngeal surgery with a suspected cancer of the Larynx (Voice Box).
Anesthesia for Microlaryngeal Surgery
Anesthesia for micro laryngoscopy surgery creates many obstacles for the anesthetists and ENT Surgeons. The anesthesia techniques for Microlaryngoscopy using suspension and the operating microscope have been fully developed and safe.
Almost all micro laryngeal surgery is done with the patient under general anesthesia. The patient must be anesthetized strongly enough so that he does not gag with the laryngoscope in place, so that he doesn’t feel anything, and that he have no memory of the surgery. During the surgery the patient must be given oxygen and the carbon dioxide produced in the lungs must be removed. This is usually accomplished by a combination of intravenous medications and the use of anesthetic gases. The gases and oxygen are given by first passing an endo tracheal tube through the vocal folds into the upper windpipe. This is called intubation.
When operating on the vocal folds, the endo tracheal tube can get in the way. There are a few techniques that can be used to minimize this problem. First, the anesthetist can use a very small tube. Second, a type of ventilation called jet ventilation can be used in which the oxygen and gases are blown into the lungs under a higher pressure. Jet ventilation requires either no tube or a very narrow tube, and gives the surgeon more room.