Anestheiologists face the difficulty of mainatining patent airway in performing anestheia for surgery around vocal cords. Because the simplicity of the above operation, the surgeons and patients tend to avoid the preparatory tracheostomy which is a safe way of maintaining anesthesia. The difficulties and problems occurring during anesthesia without performing tracheotomy were considered.
The problems were; 1) Operating field interfering the anesthetic procedures. 2) Possibility of aspiration of blood during operation. 3) Apnea time of surgery limiting to 5 minutes or less. 4) Repeated intubation for anestheic procedure.
Apneic insufflation method was modified by spontaneous respiration. The tehnicc was; the endotrachel tube was removed after induction of general anesthesia when patient´s spontaneous respiration regained Then suction catheter, 12fr. size, was inserted to above the carina of trachea. Next, for ventilation, oxygen with high flow rate (9∼10 L/Min) was insufflated in trachea through the catheter. This insufflation of high flow oxygen brought continuous positive pressure in trachea, also it acted effectively as PEEP (positive end expiratory presure) effect and provided protective mechanism from the apiration. The addition of potent anesthetics such as halothane and ether insufflating oxygen allowed the control of depth of anestheia effectively.
With this insufflation technic, two cases of excision of singer´s nodule were performed uneventfully.
|