Use of a carbon dioxide laser for treatment of recurrent laryngeal papillomatosis in small children: Experiences with an anaesthetic technique

Spontaneous respiration anesthesia for respiratory papillomatosis

Several anesthetic techniques for microlaryngeal laser surgery in children have been advocated. The objective of this study was to evaluate the operative conditions and safety of the spontaneous respiration anesthesia technique for carbon dioxide laser surgery in children with recurrent respiratory papillomatosis (RRP). The anesthetic and operative records of 60 pediatric patients with RRP who underwent microlaryngeal laser surgeries between 1991 and 1997 were reviewed. Papilloma location, severity of involvement, oxygen saturation, airway stability, need for intubation, duration of procedure, and complications were recorded. The patients underwent 744 surgical procedures. Two hundred two procedures were randomly studied (statistical power > or = 80%). The supraglottis and glottis were most commonly involved. Most of the papillomas were graded as moderate or severe disease. Complications occurred in 11 procedures. The surgical procedure was completed in all cases. No variable had predictive value regarding the outcome. Spontaneous respiration anesthesia is an efficient and relatively safe technique for microlaryngeal laser surgery in children with RRP.

Laryngeal papillomatosis with subsequent development of papillomata in the paranasal sinuses--is it seeding by intubation?

Concern has been expressed regarding the seeding of viral DNA, in laryngeal papillomatosis, to other sites in the respiratory tract during treatment. Controversy exists regarding the concept of seeding by the laser plume. However, instrumentation and anaesthetic intubation are also strongly implicated in seeding DNA to the proximal respiratory tract. No cases of recurrent laryngeal papillomatosis and subsequent papilloma in the paranasal sinuses have been reported.

Tubeless anesthetic technique for optimal carbon dioxide laser surgery of the larynx

PURPOSE

To evaluate the operative conditions and safety of a tubeless technique of anesthesia for carbon dioxide laser surgery of the larynx.

MATERIALS AND METHODS

This prospective study evaluated 78 consecutive procedures in 72 adult patients undergoing carbon dioxide laser microlaryngeal surgery. Anesthesia was maintained by an intravenous infusion of Propofol (ICI Pharmaceuticals, Cheshire, UK) while the patient breathed spontaneously without endotracheal intubation.

RESULTS

The operative conditions were optimal in 76 of the 78 procedures providing a clear uninterrupted view of the larynx with no combustible material in the surgical field.

CONCLUSIONS

This series shows the technique described to be safe without risk of combustion and provides an unobstructed view to the larynx.