A common cause of snoring is palatal flutter which occurs when turbulent airflow causes the flexible soft palate to flutter. Surgical correction involves either removal of the soft palate or a reduction in its flexibility. Laser pharyngoplasty is a new surgical procedure designed to stiffen the soft palate. It presents a unique combination of problems for the anaesthetist. In this paper we describe the evolution of the anaesthetic technique for laser pharyngoplasty and analyse the results of the first 165 cases. Points of particular interest include the use of the reinforced laryngeal mask airway compared with the tracheal tube and late onset pain.
LugaresiR., CarignottaF., CoccagnaG., PianaC.Some epidemiological data on snoring and cardio-respiratory disturbances. Sleep1980; 3: 221–224.
2.
EllisP.D.M., WilliamsJ.E.F., ShneersonJ.M.Surgical relief of snoring due to palatal flutter: a preliminary report. Ann Roy Coll Surg Eng1993; 75: 286–290.
3.
SherA.E., ThorpyM.J., ShprintzenR.J., SpielmanA.J., BurackB., McGregorP.A.Predictive value of Muller maneuvre in selection of patients for uvulopalatopharyngoplasty. Laryngoscopy1985; 95: 1483–1487.
4.
FujitaS., ConwayW., ZorickF., RothT.Surgical correction of anatomic abnormalities in obstructive sleep apnoea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg1981; 89: 923–934.
5.
SharpJ.F., JalaludinM., MurrayJ.A.M., MaranA.G.D.The uvulopalatopharyngoplasty operation: the Edinburgh experience. J Royal Soc med1990; 83: 569–570.
6.
Blair SimmonsF., GuilleminaultC., MilesL.E.The palatopharyngoplasty operation for snoring and sleep apnoea: an interim report. Otolaryngol Head Neck Surg1984; 92: 375–380.
7.
CroftC.B., Golding-WoodD.G.Uses and complications of uvulopalatoplasty. J Laryngol Otolog1990; 104: 871–875.
8.
FairbanksD.N.F.Uvulopalatopharyngoplasty complications and avoidance strategies. Otolaryngol Head Neck Surg1990; 102: 239–245.
9.
TullyA., BrantiscanoT., LoringS.H., EngelL.A.Influence of posterior cricoarytenoid muscle activity on pressure-flow relationship of the larynx. J Appl Physiol1991; 70: 2252–2258.
CormackR.S., LehaneJ.Difficult tracheal intubation in obstetrics. Anaesthesia1984; 39: 1105–1111.
13.
LugaresiE., CirignottaF., CoccagnaG., PianaC.Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep1980; 3: 221–224.
14.
NortonP.G., DunnE.V.Snoring as a risk factor for disease: an epidemiological survey. Br Med J1985; 291: 630–632.
15.
PartinenM., PalomakiH.Snoring and cerebral infarction. Lancet1985; 2: 1325–1326.
16.
IkematsuI.Clinical study of snoring for the past 30 years. In: ChouardC.H., ed. Chronic rhoncopathy.London: John Libbey Eurotext, 1988; 5–14.
17.
SaundersN.A., VandeleurT., DevesJ.Uvulopalatopharyngoplasty as a treatment for snoring. Med J Aust1989; 150: 177–182.
18.
SamelsonC.F.Sequelae and complications of palatopharyngoplasty: impact on vocal trill. Sleep1984; 7: 83–84.
19.
CaldarelliD.D., CartwrightR., LilieJ.K.Severity of sleep apnoea as a predictor of successful treatment of palatopharyngoplasty. Laryngoscopy1986; 96: 945–947.
20.
BorowieckeB., KukwaA.A., BlanksR.I.H.Indications for palatopharyngoplasty. Arch Otolaryngol1985; 111: 659–663.
21.
AndohK., ShimaT., TajimaT., HoshiK., HashimotoY.Perioperative management of uvulopalatopharyngoplasty for the obstructive sleep apnoea patient. Masui1992; 41: 140–144.
RoseD.K., CohenM.M.The airway: problems and predictions in 18,500 patients. Can J Anaesth1994; 41: 372–383.
24.
WilliamsP.J., BaileyP.M.Comparison of the reinforced laryngeal mask airway and tracheal intubation for adenotonsillectomy. Br J Anaesth1993; 70: 30–33.
25.
WebsterA.C., Morley-ForsterP.K., DainS.Anaesthesia for adenotonsillectomy: a comparison between tracheal intubation and the armoured laryngeal mask airway. Can J Anaesth1993; 40: 1171–1177.
26.
EpsteinR.H., HalmiB.H.Oxygen leakage around the laryngeal mask airway during laser treatment of port-wine stains in children. Anesth Analg1994; 78: 486–489.
27.
EpsteinR.H., HalmiW.Oxygen leakage around the laryngeal mask airway during laser treatment of port wine stains in children. (Abstract). Anesthesiology1993; 79: A1154.
28.
DivatiaJ.V., SareenR., UpadhyeS.M., SharmaK.S., ShelgaonkarJ.R.Anaesthetic management of tracheal surgery using the laryngeal mask airway. Anaesth Intens Care1994; 22: 69–73.
29.
SlingerP., RobinsonR., ShennibH., BenumofJ.L., EisenkraftJ.B.Alternative technique for laser resection of a carinal obstruction. J Cardiothorac Anesth1992; 6: 749–755.
30.
MahiouP., NarchiP., VeyracP., GermondM., GoryG., BazinG.Is laryngeal mask easy to use in case of difficult intubation? (Abstract). Anesthesiology1992; 77: A1228.
31.
BrimacombeJ., BerryA.Mallampatti classification and laryngeal mask insertion. Anaesthesia1993; 48: 347.
JohnR.E., HillS., HughesT.J.Airway protection by the laryngeal mask—a barrier to dye placed in the pharynx. Anaesthesia1991; 46: 366–367.
34.
BrimacombeJ., SherM., LaingD.The incendiary characteristics of the laryngeal and reinforced laryngeal mask airway. Anaesthesia1994; 49: 171.
35.
Guide to the safe use of lasers in health care.Sydney: Publication Standards of Australia—AS/NS25 4173, 1994.
36.
BrimacombeJ.The incendiary characteristics of the laryngeal and reinforced laryngeal mask airway to CO2 laser strike—a comparison with two polyvinyl chloride tracheal tubes. Anaesth Intens Care (in press).
37.
BrimacombeJ., SherM.The laryngeal mask airway for laser surgery to the aerodigestive tract. Anaesthesia (in press).
38.
HickeyD.R., ScottA.Propofol for laryngeal mask insertion. (Abstract). Can J Anaesth1993; 40: A35.
39.
ScanlonP., CareyM., PowerM., KirbyF.Patient response to laryngeal mask insertion after induction of anaesthesia with propofol or thiopentone. Can J Anaesth1993; 40: 816–818.
