APNEIC ANESTHESIA WITH INTERMITTENT VENTILATION FOR MICROSURGERY OF THE UPPER AIRWAY

Apneic anesthesia with intermittent ventilation (AAIV) has been used i n 250 procedures on the larynx and trachea at Indiana University Medic al Center since October 1989. Initially employed for laryngeal papillo ma removal in children, this anesthetic technique is now used for othe r procedures and in adult patients. The advantages of AAIV include imp roved visualization of the airway, absence of combustible material, an d lack of vocal cord motion during surgery. No significant complicatio ns have occurred with AAIV. The high degree of safety for this anesthe tic technique relates largely to the constant monitoring of oxygen sat uration using pulse oximetry and the periodic measurement of end-tidal carbon dioxide (CO2) levels. Contraindications to AAIV are age less t han 2 years, significant cardiopulmonary disease, and any hypermetabol ic state. Relevant pulmonary physiology includes the unique aspects of oxygen and CO2 metabolism in children.