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Anesthesia Considerations in Office-Based and OR-Based Laryngeal Surgery - 2
Book chapter   Open access

Anesthesia Considerations in Office-Based and OR-Based Laryngeal Surgery - 2

Abdul-Latif Hamdan, Robert Thayer Sataloff, Omar Ramadan, Daniel Eichorn and Mary J Hawkshaw
01 Jan 2023
DOI: https://doi.org/10.1007/978-3-031-35283-6_2
url
http://cds.cern.ch/record/1729721View
SubmittedOpen Access (License Unspecified),  Open

Abstract

With the advances in technology, benign and pre-malignant lesions of the vocal folds are often treated in-office under local anesthesia. Several treatment modalities are offered to the patient, among which is laser therapy. This shift in practice is based on successful application of local anesthesia to the upper airway. The topical anesthetic can be administered via the oral route or the transnasal route using the working channel of the flexible endoscope. An alternative approach is transcervical injection via the cricothyroid membrane of thyrohyoid membrane. Adequate application of local anesthesia to the oropharynx and larynx allows the physician to navigate safely with the endoscope while using the laser glass fiber for the treatment of laryngeal pathology. The patient tolerance and surgeon’s expertise are key factors for improved voice outcome following treatment. In addition to establishing patient comfort, the laryngologist is responsible for maintaining safety. When performed in the operating room, laser therapy requires special precautions that are partially fulfilled by the anesthesiologist. Patient-related precautions include the use of a special endotracheal tube and oxygen concentration (less than 30%) protection of the eyes and skin among others. Working environment safety measures are also extremely important. Proper communication and close collaboration between the surgeon and anesthesia team are essential.

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