Anesthetic management for CO2 laser treatment of laryngeal papilloma under self-retaining laryngoscope in children / 中华麻醉学杂志

ABSTRACT

Twenty-eight children with laryngeal papilloma aged 10 months -3.5 yr weighing 8-15 kg received CO2 laser treatment under serf-retaining laryngoscope from May 2003 to May 2007. There were 17 patients without laryngeal obstruction, 7 patients with 1st degree laryngeal obstruction and 4 patients with 2rid or 3rd degree laryngeal obstruction. Different techniques of anesthesia were used for patients with different degrees of laryngeal obstruction. In patients without laryngeal obstruction anesthesia was induced with intramuscular ketamine 5 mg/kg. After the patients lost consciousness midazolam 0.1 mg/kg, ketamine 1-2 mg/kg or fentanyl 2 μg/kg was given iv. Tracheal intubation was facilitated with succinyl-cboline 1.5 mg/kg. In patients with 1st degree laryngeal obstruction, ketamine 5 mg/kg was given ira. The patients kept spontaneous breathing. Tracheal intubaiion was pedormed under topical anesthesia with 1% tetracaine. In patients with 2nd and 3rd degree laryngeal obstruction tracheal intubation was performed awake without any premedication under topical anesthesia with 1% tetracaine. The trachea was intubated with the tracheal tube 1 size smaller than the regular size. Anesthesia was maintained with propofol 3-5 mg·kg1·h-1 and intermittent iv boluses of ketamine 1-2 mg/kg and vecuronium 0.05-0. 1 mg/ kg. Dexamethasone 0.2-0.3 mg/kg was given iv at the end of operation. The patients were extubated when the patients regained consciousness and SpO2≥ 96% on air. In one patient with Ist degree laryngeal obstruction emergency tracheotomy was performed during induction of anesthesia. Anesthesia was otherwise smooth and recovery was uneventful.