Efficacy of total intravenous anesthesia without intubation for laryngeal framework surgery.
CONCLUSIONS
Total intravenous anesthesia (TIVA) without intubation has the advantages of both conventional general anesthesia and local anesthesia. It is useful in laryngeal framework surgery because intraoperative voice monitoring while the patient remains awake is required.


OBJECTIVE
In laryngeal framework surgery, it is desirable to monitor the voice during surgery. However, surgery is conducted under general anesthesia, although such a procedure renders the patient unable to phonate during surgery. We conducted TIVA without intubation, allowing patients to breathe spontaneously while undergoing operation, and succeeded in intraoperative voice monitoring with satisfactory postoperative voice production.


METHODS
The subjects were 21 patients who underwent surgery. For TIVA, propofol and pentazocine were used as a sedative and analgesic, respectively. A bispectral index (BIS) monitor was used to measure the depth of the anesthesia. Before the vocal folds were to be rotated, propofol administration was interrupted to arouse and instruct the patient to phonate. Guided by the phonation, the vocal folds were correctly positioned. Then propofol administration was resumed, and the wound was closed.


RESULTS
The BIS value during continued administration of propofol was around 60, but exceeded 90 in all patients within 233.6 +/- 64.5 s after cessation. They clearly remembered the conversation they had with us during surgery.
Nakamura
Kazuhiro
K
Department of Head & Neck Surgery, Hachioji Medical Center, Tokyo Medical University, Japan. eddy@tokyo-med.ac.jp
Muto
Takao
T
Yoshida
Tomoyuki
T
Hiramatsu
Hiroyuki
H
Watanabe
Yusuke
Y
Suzuki
Mamoru
M
D000368:Aged; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007817:Laryngeal Cartilages / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010038:Otorhinolaryngologic Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D015742:Propofol / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014831:Voice / Q000502:physiology
D018686:Anesthetics, Intravenous; D015742:Propofol