TUBELESS SPONTANEOUS RESPIRATION TECHNIQUE FOR PEDIATRIC MICROLARYNGEAL SURGERY

Background: Tubeless spontaneous respiration technique for pediatric m icrolaryngeal surgery may be accomplished using different anesthetic p rotocols. Two methods, inhalation of volatile anesthetic agents alone and in combination with intravenous propofol, are reviewed with regard to intraoperative airway stability, postoperative morbidity, recovery room course, and halothane concentration required during maintenance anesthesia. Design: Retrospective case series. Setting: Otolaryngology referral hospital. Patients and Methods: Twenty-nine microlaryngeal p rocedures were performed using tubeless spontaneous respiration techni que in children ranging from 2 weeks to 11 years of age. The following 2 anesthetic protocols were used: inhaled volatile anesthetic agents alone in 18 procedures and in combination with intravenous propofol in 11. Anesthesia, surgery, and recovery room times were documented. Spe cific characteristics of anesthetic maintenance, including total anest hetic gas flow (liters per minute), variations of halothane concentrat ion (percentage), and duration of halothane administration (minutes) w ere also recorded to calculate the mean concentration of halothane (pe rcentage) delivered to each patient. Results: No statistical differenc es were observed between the 2 protocols in terms of anesthesia and su rgical outcomes. Adjusting for differences in patient age, weight, mai ntenance duration, and total anesthetic gas flow, the introduction of propofol allowed a statistically significant reduction in the mean con centration of halothane required during maintenance anesthesia. Conclu sions: Both tubeless spontaneous respiration technique protocols prove d successful in this study. However, the addition of propofol allowed a significant reduction in the halothane requirement during anesthesia maintenance. This has the potential benefit of decreasing the exposur e of operating room personnel to volatile anesthetics during tubeless spontaneous respiration technique.