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CARDIOVASCULAR ANESTHESIA

Anesthesia for Endobronchial Laser Surgery: A Modified Technique

Giorgio Medici, MD^*, Chris Mallios, MD^*, Wil T. Custers, MD, Jan P. van Meerbeek, MD, PhD, Gert T. Verhoeven, MD, and Wim C. J. Hop, PhD^§

Departments of *Anesthesiology and Pulmonary Medicine, University Hospital Dijkzigt, Rotterdam; Department of Anesthesiology, Diaconessenhuis Eindhoven, Eindhoven; and §Department of Epidemiology & Biostatistics, Erasmus University, Rotterdam, The Netherlands

Address correspondence and reprint requests to G. Medici, Department of Anesthesiology, University Hospital Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

We describe a technique for endobronchial surgery with the neodynium:yttium-aluminum-garnet laser, in which an insufflation catheter with side holes placed into the contralateral mainstem bronchus is used for high-frequency positive pressure ventilation. Thirty-five patients (45 procedures) were treated during general anesthesia using a rigid bronchoscope in combination with a fiberoptic bronchoscope. Perioperatively, oxygen saturation (SaO₂), mean arterial pressure, and heart rate were recorded. SaO₂ during the recovery period was comparable to that during the intraoperative period but was significantly (P < 0.05) higher than that before the induction of anesthesia. There was a considerable (5%) increase in SaO₂ at the end of the treatment in six patients, which indicates that the recanalization of the treated airway was successful. Our data support the assumption that, during endobronchial resection, selective ventilation of the nonaffected lung was adequate; in addition, subcarinal placement of the insufflation catheter with side holes was advantageous. We conclude that this technique contributes to the prevention of lung complications during endobronchial laser surgery.

Implications: We describe a technique in which an insufflation catheter with side holes placed into the contralateral mainstem bronchus largely prevented inhalation of laser smoke and aspiration of blood and debris.

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