Tubeless anaesthesia with sevoXurane and propofol in adult laryngeal surgery

The presence of endotracheal intubation tube or jet ventilation cannula can compromise free view and access to operation area in certain endolaryngeal operations. The objective of this prospective study was to test whether adequate level of anaesthesia could be obtained in adults using tubeless sevoXurane inhalation anaesthesia with spontaneous breathing. In 23 ASA 1–2 patients, 31 treatments were included in the study of which 19 were laser-assisted papilloma or other tumour resections and 12 were fascia injection laryngoplasties. Anaesthesia was induced with propofol and maintained by insuZating sevo- Xurane mixture to the patient’s oropharynx. The adequacy of the anaesthesia level was assessed by monitoring bispectral index, haemodynamic parameters and peripheral oxygen saturation during the anaesthesia. The ENT surgeon estimated operating conditions, whilst the two participating anaesthesiologists assessed the quality of anaesthesia using a 100 mm VAS scale. SevoXurane contamination in the operating theatre was measured during Wve treatments. Mean bispectral index was below 40 throughout the operation. Haemodynamic parameters showed only minor changes during the anaesthesia. Both attending anaesthesiologists and operating ENT surgeon were satisWed with the quality of the anaesthesia and operating conditions (VAS 83 § 15, mean § SD, range 42–100, and VAS 93 § 10, range 55– 100, respectively). SevoXurane room air contamination was high in most measured cases. The modiWcation of tubeless inhalation anaesthesia used in this study produced adequate level of anaesthesia with stable haemodynamics and good operating conditions. SevoXurane contamination can be reduced with more eYcient scavenging systems