Efficacy of Total Intravenous Anesthesia (TIVA) without Intubation for Laryngeal Framework Surgery

DOI Web Site 17 Citations 35 References
  • Nakamura Kazuhiro
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Yoshida Tomoyuki
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Muto Takao
    Department of Anesthesia, Tokyo Medical University Hachioji Medical Center
  • Suzuki Nobuhiro
    Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Watanabe Yusuke
    Department of Otorhinolaryngology, International University of Health and Welfare MITA Hospital
  • Tokashiki Ryoji
    Department of Otorhinolaryngology, Tokyo Medical University
  • Suzuki Mamoru
    Department of Otorhinolaryngology, Tokyo Medical University

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Other Title
  • 喉頭枠組み手術における無挿管全静脈麻酔の有用性
  • コウトウ ワクグミ シュジュツ ニ オケル ムソウカン ゼン ジョウミャク マスイ ノ ユウヨウセイ

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Abstract

In laryngeal framework surgery (arytenoid adduction and thyroplasty type 1), it is desirable to monitor the patient's phonation capacity during surgery ; therefore, local anesthesia has been selected in most instances. At some institutions, however, surgery (arytenoid adduction) is conducted under general anesthesia by tracheal intubation, although such a procedure renders the patient unable to phonate during surgery.<br>The authors conducted total intravenous anesthesia (TIVA) without intubation, allowing patients to breathe spontaneously while undergoing laryngeal framework surgery, and succeeded in intraoperative voice monitoring with satisfactory postoperative voice production. The details are described below.<br>The subjects were 14 patients who underwent laryngeal framework surgery at the Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center between December 2002 and April 2005.<br>For TIVA, propofol and pentazocine were used as a sedative and analgesic, respectively. A bispectral index (BIS) monitor was used as an indicator for measuring depth of the anesthesia. No pre-anesthetic medication was administered. After the patient was brought to the operating room, 15 to 30 mg/body of pentazocine was administered intravenously, followed by continuous intravenous infusion of 10 mg/kg/hr of propofol for the drug to take effect while the patient was breathing spontaneously without intubation. After induction of the anesthesia, 4 to 6 mg/kg/hr of propofol was administered and continued for maintenance. Before the vocal cords were to be rotated inwardly, propofol administration was interrupted in order to arouse and instruct the patient to phonate. Guided by the phonation, the vocal cords were correctly positioned. Then propofol administration was resumed in order to return the patient to an anesthetized state, and the wound was closed.<br>Intraoperative management and postoperative voice production were satisfactory in all patients. The BIS rate during continued administration of propofol was around 60, but exceeded 90 in all patients within 226±66 seconds after cessation. They clearly remembered the conversation they had with us during surgery. None reported intraoperative pain. Postoperative MPT improved in all.<br>TIVA with spontaneous respiration by patients without resorting to intubation has the advantages of both conventional general anesthesia via tracheal intubation and local anesthesia. It is useful in laryngeal framework surgery wherein intraoperative voice monitoring while the patient remains awake is required.

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