[Working conditions and complications during laryngomicroscopies under endotracheal ventilation via intubation tubes or injection ventilation].
During a period of 7 years 693 laryngomicroscopies (LAR) were performed on 490 patients. General anaesthesia was given by 21 anaesthesists: 5 applied ventilation only through a conventional intubation tube. Of the remaining 16 anaesthesists, 8 constantly prefered, 4 used occasionally jet ventilation (JET), and 4 applied both methods alternatively. No rationale was found for this choice. Laryngomicroscopies were performed by 14 ENT surgeons. One case of subcutaneous emphysema and two of pneumothorax were obtained with JET, obviously because of inexperience and neglect of precautions. Two epidermoid carcinomas in the left posterior commissure escaped the primary LAR, most probably because of poor vision due to the intubation tube, and were found during subsequent procedures with JET. In spite of the risk of complications (mostly avoidable with care and increasing experience), the main advantage of JET is the better chance of revealing of carcinoma in an earlier phase, when it is more amenable to curative therapy. Therefore, we no longer recommend ventilation through an intubation tube for laryngomicroscopies, but prefer intratracheal jet-ventilation for this purpose.
D000758:Anesthesia; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007822:Laryngeal Neoplasms / Q000175:diagnosis; D007828:Laryngoscopy / Q000009:adverse effects*; D011030:Pneumothorax / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation; D013352:Subcutaneous Emphysema / Q000209:etiology
Arbeitsbedingungen und Komplikationen bei Laryngomikroskopien, intratracheal ventiliert durch Intubationstuben oder mit Injektor-Ventilation.