Airway management for microlaryngeal surgery

Theoretical basis: Microlaryngeal surgery can be conducted in an awake patient, frequently under conscious sedation, or with the patient anesthetized. The ventilation options under general anesthesia consist of “tube” (i.e., endotracheal intubation) and “tubeless” techniques, with the latter represented by the techniques of Spontaneous ventilation, Apneic intermittent ventilation (AIV), and Jet Ventilation (JV). Results: The use of a small (5.0-mm ID) MLT tube with positive-pressure ventilation remains the standard for airway management in most nonlaser microlaryngeal surgery, and it is associated with minimal or no intraoperative complications. Spontaneous ventilation is rarely used in adult microlaryngeal surgery, but it is commonly employed in the pediatric patient population. AIV remains a relatively popular technique for microlaryngeal surgical procedures of short duration in some surgical centers. Superimposed High-Frequency Jet Ventilation (SHFJV), which combines highfrequency and low-frequency ventilation modes, has been used effectively in surgical treatment of high-grade laryngeal and tracheal stenosis. Conclusion: General anesthesia for microlaryngeal surgery represents a unique example of close cooperation between the surgeon and the anesthesiologist.