Recurrent respiratory papillomatosis is a common neoplastic process affecting the pediatric larynx. The CO2 laser is the most common method of therapy used in its control. Surgical management is complicated by the presence of an endotracheal tube that limits access to glottic and subglottic disease and poses the risk of a fire in the patient's airway when a laser is used to ablate the papillomas. An anesthetic technique has been developed that avoids the use of an endotracheal tube and the attendant risks described. The technique depends on the maintenance of deep anesthesia with insufflated halothane and spontaneous breathing. Halothane concentrations of 3–4% and an oxygen flow of 5 L/minute eliminate significant room air dilution in the airway and provide a satisfactory operative field. Positive pressure is needed infrequently but may be provided by occluding the proximal end of the operating laryngoscope with the thumb while the anesthesiologist squeezes the breathing bag, allowing oxygen and anesthetic agents to be delivered through a Frazer suction tip with the finger hole closed placed within one of the light channels of the laryngoscope.
ASJC Scopus subject areas
- Biomedical Engineering