Anesthetic Management for Video Laryngotracheoscopy in Pediatric Patients

Abstract

We report our experience with anesthesia for video laryngotracheoscopy in pediatric patients. Our management is based on general intravenous anesthesia with propofol followed by topical anesthesia of the airway with lidocaine. The oxygen saturation is continuously monitored by pulse oximetry. This approach does not compromise the patient's spontaneous ventilation and enables the assessment of the functional, dynamic aspects of the airway. The examination is carried out with the flexible fiberoptic bronchoscope and is interrupted when oxygen saturation drops to 90% to allow manual ventilation by face mask and 100% oxygen. When apnea is necessary to enable operative maneuvers, mivacurium is added to propofol, and endoscopy is carried out with the rigid optical telescope. This instrument is removed from the airway as soon as the oxygen saturation starts to fall. When the operative time is longer, a tracheal tube is inserted and removed according to the oxygen saturation as above. With this approach, we obtain a quiet, unconscious patient, dangerous airway reflexes are blunted by topical anesthesia, and the patient's oxygenation and ventilation are always well controlled and managed. Life-threatening falls of oxygen saturation or cardiac dysrhythmias have never occurred. The most common complications were mild, transient oxygen desaturation and postoperative laryngeal edema. Because of this potential for edema, we always plan availability of admission to the intensive care unit.