The use of a double‐lumen central venous catheter for airway management in pediatric patients undergoing laryngeal papillomatosis surgery. Issue 2 (19th August 2013)

• Record Type: Journal Article
• Authors: Zhu, Zhi‐rui; Hu, Zhi‐yong; Jiang, Yi‐lei; Xu, Li‐li; McQuillan, Patrick M.; Cote, Charles
• Is Part Of: Paediatric anaesthesia. Volume 24:Issue 2(2014)
• Page Start: 157
• Page End: 163
• Publication Date: 2013-08-19
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12253
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12253-abs-0001"> <title>Summary</title> <sec id="pan12253-sec-0001" sec-type="section"> <title>Purpose</title> <p>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.</p> </sec> <sec id="pan12253-sec-0002" sec-type="section"> <title>Methods</title> <p>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<sup>−1</sup> through the 14G (larger lumen) of the DLCVC. Endtidal carbon dioxide tension (PetCO<sub>2</sub>) was monitored using the other lumen of the DLCVC, which was connected to the CO<sub>2</sub> 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 (SpO<sub>2</sub>), and PetCO<sub>2</sub> were also monitored. Arterial blood was sampled for blood gas analysis including pH, PaO<sub>2</sub>, PaCO<sub>2</sub>, and actual base excess (ABE). Complications, including intraoperative patient movement, hypoxemia (SpO<sub>2</sub> < 95% during oxygen insufflation), nausea, vomiting, bronchospasm, and arrhythmias, were recorded.</p> </sec> <sec id="pan12253-sec-0003" sec-type="section"> <title>Results</title> <p>There was a significant increase in PetCO<sub>2</sub> and PaCO<sub>2</sub> (<italic>P</italic> values <0.05) as well as a decrease in ABE, pH, and PaO<sub>2</sub> (<italic>P</italic> values <0.05) in samples collected before and after surgery. MAP, HR, and SpO<sub>2</sub> after surgery were not significantly different from after induction values (<italic>P</italic> values >0.05). During surgery, SpO<sub>2</sub> < 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.</p> </sec> <sec id="pan12253-sec-0004" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>