Fiberoptic Laryngeal Laser Surgery

With recent developments in medical technology and the introduction of various types of lasers, the role of fiberoptic laryngeal laser surgery (FLS) in laryngology has been significantly expanded. FLS are typically performed under local anesthesia, and patients may return to normal activities immediately after the procedure. This corresponds to the current trend of minimally invasive surgery and may limit unnecessary general anesthesia, reduce medical costs, and increase patient compliances. Main indications of FLS procedure were vocal polyp, recurrent respiratory papillomatosis, vocal fold granuloma and vocal fold dysplasia. In this review, we discuss practical tips and unique value of FLS.

Intubación con paciente despierto con fibroscopio retromolar de Bonfils bajo sedación con dexmedotomidina. Reporte de 7 casos / Awake insertion of the Bonfils retromolar intubation fiberscope

Diversas guías de manejo y algoritmos para el manejo y control de la vía aérea difícil recomiendan la intubación con el paciente despierto, como un método seguro. En los últimos años la intubación en paciente despierto se ha realizado con fibroscopio flexible o mediante laringoscopia clásica y directa . Últimamente se han desarrollado múltiples dispositivos ; entre dichos estiletes se destaca el fibroscopio retromolar de Bonfils; este es un instrumento óptico semi-rígido en una curva anterior de 40 grados. Al acomodarlo dentro de un tubo endotraqueal y pasarlo por la vía aérea superior, es posible dirigirlo bajo visión directa a la glotis. Se presentan en esta serie 7, casos de intubación en pacientes con vía aérea complicada, bajo sedación con dexmedetomidina con fibroscopia retromolar de Bonfils, sin aplicación de anestesia tópica.

Acording to the “Practice Guidelines for management of a difficult airway”, and several algorithnes, an awake intubation is considered the first method to secure a suspected difficult airway. During last years the awake intubation was performed by flexible fiberoptic laringoscopy or with a rigid stylet. Within the last decade, many new devices have been developed to assist anesthesiologist with both routine and difficult airway management, one of wich is the Bonfils Retromolar Intubacion Fiberscope. It is a semi-rigid optical stylet 40 cm. long of 5,0 external diameter and a tip curvature of 40 degrees; the adult stylet can accommodate a 6,5 mm. endotracheal tube and sliding it in the superior airway, it is possible to entubate the glottis under direct vision. We present seven case report with difficult airway, managed with dexmedotomidine using the Bonfils retromolar fiberscope without topical anesthetic.