title: Spontaneous ventilation using Propofol TCI for microlaryngoscopy in adults: a retrospective audit.
abstract: We conducted a retrospective audit of 285 adult elective microlaryngoscopy cases in our institution over a three-and-a-half year period. Conventional anaesthesia with intubation and mechanical ventilation was the most common technique, used in 71% of cases. Tubeless spontaneous ventilation during total intravenous anaesthesia with a target-controlled infusion of propofol (SVTCI) was the most common alternative. Spontaneous ventilation with target-controlled infusion was used for 79 (27.7%) anaesthetic inductions and was continued through the maintenance phase for 60 patients (21.1%). Jet and intermittent ventilation were both used infrequently (1% each). The most common SVTCI technique since 2013 involved adjusting the target-controlled infusion rate during induction using a formula we developed based on intermittently increasing the target rate, such that the predicted plasma concentration minus the predicted effect site concentration was maintained at 1 µg/ml. We found that this method maintained ventilation during induction more reliably than other SVTCI strategies, and was associated with fewer complications than other spontaneous ventilation techniques or mechanical ventilation: it was associated with only one (3.1%) failed induction and one (3.9%) episode of apnoea. Jet ventilation was associated with the most severe complications, including two cases of barotrauma.
authors.affiliation: Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland.
authors.forename: A W G
authors.initials: AW
authors.lastname: Booth
authors.affiliation: Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Queensland.
authors.forename: K
authors.initials: K
authors.lastname: Vidhani
mesh_terms: D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D012119:Respiration; D012189:Retrospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol
keywords: anaesthesia; apnoea; artificial respiration; barotrauma; propofol