Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale
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Acta Otorhinolaryngol Ital · Oct 1995
Comparative Study[The treatment of benign laryngeal pathologies using CO2 laser in direct microlaryngoscopy with propofol-induced endovenous anesthesia in spontaneous respiration without intubation].
Direct microlaryngoscopy is an endoscopic technique with considerable diagnostic and surgical potentialities, which are increased when carbon-dioxide Laser is used, but often limited by the anaesthesiologic methods employed. In fact, the traditional anaesthesiologic technique, which uses small bore oral-tracheal tubes and provides good ventilation, has significant disadvantages: the tube often impedes surgical activity especially in the posterior regions of the larynx; stenoses of the larynx impede oral-thacheal intubation and thus require pre-operatory thacheotomy; administration of succinylcholine often induces diffused myalgia in the following 12-24 hours; administration of traditional narcotics always requires hospitalization. Jet-ventilation used by the Freach School as an alterative, while offering a more ample operatory space, is also accompanied by many disadvantages: vocal cords vibration; spray expulsion of smoke, blood, etc.; as with the traditional method, it cannot be employed in cases of laryngeal stenoses; succinylcholine often induces diffused myalgia; it cannot be used on out-patients. ⋯ The pharmacologic protocol of this narcosis require intravenous premedication with atropine and phentanyl, induction and continuation with Propofol and pharyngolaryngeal local anaesthesia with lidocaine spray. The advantages offered by this method are considerable: a completely free operative space; the possibility of being used in cases of laryngeal stenosis; a rapid return to consciousness; the absence of myalgia after surgery; the possibility of treating the disease on an out-patient basis. The absence of significant complications and the good results obtained lead us to propose this anaesthesiologic method as a valid alternative to anaesthesia by the traditional oral-tracheal intubation and to Jet ventilation.
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Posterior laryngeal granuloma is an infrequent pathology of multidisciplinary interest. Actually, its real prevalence is difficult to quantify because in some cases it is asymptomatic and in other instances it may either be reabsorbed or eliminated spontaneously. It is located at the vocal apophysis of the arytenoid or, less frequently, above it or on the laryngeal side of the arytenoid. ⋯ In all the ten patients rehabilitated up to now, granulomas disappeared after a mean of 16.3 sessions held twice a week. After several months of follow-up we had no recurrences. This clinical experience, while limited in number, seems to confirm the good results already reported in French Literature.