Anesthesia for endobronchial laser surgery: A modified technique

We describe a technique for endobronchial surgery with the neodynium:yttium -aluminum-garnet laser, in which an insufflation catheter with side holes p laced into the contralateral mainstem bronchus is used for high-frequency p ositive pressure ventilation. Thirty-five patients (45 procedures) were tre ated during general anesthesia using a rigid bronchoscope in combination wi th a fiberoptic bronchoscope. Perioperatively, oxygen saturation (Sao(2)), mean arterial pressure, and heart rate were recorded. Sao(2) during the rec overy period was comparable to that during the intraoperative period but wa s significantly (P < 0.05) higher than that before the induction of anesthe sia. There was a considerable (greater than or equal to 5%) increase in Sao (2) at the end of the treatment in six patients, which indicates that the r ecanalization of the treated airway was successful. Our data support the as sumption that, during endobronchial resection, selective ventilation of the nonaffected lung was adequate; in addition, subcarinal placement of the in sufflation catheter with side holes was advantageous. We conclude that this technique contributes to the prevention of lung complications during endob ronchial laser surgery. Implications: We describe a technique in which an i nsufflation catheter with side holes placed into the contralateral mainstem bronchus largely prevented inhalation of laser smoke and aspiration of blo od and debris.