title: The use of a double-lumen central venous catheter for airway management in pediatric patients undergoing laryngeal papillomatosis surgery.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a double-lumen central venous catheter (DLCVC) in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis.
  
  
  METHODS
  Thirty-six pediatric patients with laryngeal papillomatosis undergoing suspension laryngoscopic surgery were anesthetized with oxygen and volatile anesthetic insufflation while spontaneously breathing. Anesthesia was induced by inhalation of 8% sevoflurane in oxygen by mask. Atropine, dexamethasone, lidocaine, and midazolam were administered intravenously. The tip of a 7Fr DLCVC was inserted below the glottis after placement of the laryngoscope and establishing suspension. Anesthesia was maintained with insufflation of 4-6% sevoflurane and oxygen with a total fresh gas flow of 6 l·min(-1) through the 14G (larger lumen) of the DLCVC. Endtidal carbon dioxide tension (PetCO2) was monitored using the other lumen of the DLCVC, which was connected to the CO2 sampling line. Duration of the procedure as well as total anesthesia time was recorded. Electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), and PetCO2 were also monitored. Arterial blood was sampled for blood gas analysis including pH, PaO2 , PaCO2 , and actual base excess (ABE). Complications, including intraoperative patient movement, hypoxemia (SpO2 < 95% during oxygen insufflation), nausea, vomiting, bronchospasm, and arrhythmias, were recorded.
  
  
  RESULTS
  There was a significant increase in PetCO2 and PaCO2 (P values <0.05) as well as a decrease in ABE, pH, and PaO2 (P values <0.05) in samples collected before and after surgery. MAP, HR, and SpO2 after surgery were not significantly different from after induction values (P values >0.05). During surgery, SpO2 < 95% in three cases and body movements in three cases were observed. No patient had any other of the complications previously described. Furthermore, no postsurgical endotracheal intubation was needed in any patient.
  
  
  CONCLUSIONS
  After establishing an adequate depth of anesthesia, a spontaneous ventilation anesthesia technique with insufflation of oxygen and volatile agent through a DLCVC is feasible in pediatric patients undergoing suspension laryngoscopic surgery for laryngeal papillomatosis.
authors.affiliation: Department of Anesthesiology, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Zhi-rui
authors.initials: ZR
authors.lastname: Zhu
authors.forename: Zhi-yong
authors.initials: ZY
authors.lastname: Hu
authors.forename: Yi-lei
authors.initials: YL
authors.lastname: Jiang
authors.forename: Li-li
authors.initials: LL
authors.lastname: Xu
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McQuillan
mesh_terms: D058109:Airway Management / Q000379:methods*; D000768:Anesthesia, General; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007223:Infant; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007828:Laryngoscopy; D008297:Male; D010212:Papilloma / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D055986:Vital Signs
chemical_list: D002245:Carbon Dioxide
keywords: airway management; double-lumen central venous catheter; laryngeal papillomatosis; spontaneous ventilation; suspension laryngoscopic surgery