Preop:
Additional studies:
- CT scan: location, size, shape of the lesion
- Pulmonary function test: none needed it
- Cardiovascular Test : EKG and echo
- Chronic airway instruction:
- EKG:
- Right atrial hypertrophy: P waves in leads II, III and aVF
- Right ventricular hypertrophy: right axis deviation and partial or complete right bundle branch block
- EKG:
- Chronic airway instruction:
- Airway bleeding, airway fire, obstruction of the surgical field, seeding of the papillomas into the distant airways, failure to pass the ETT as a result of the airway obstruction, increase airway resistance, and further airway is scarring from repeated airway manipulation and surgeries.
Premedications: versed
IV placement: in preop if patient comfortable otherwise will do it in the OR
Intraop:
If the patient doesn’t have an IV, I will perform as slow inhalation induction with sevoflurane and 100% oxygen and maintain a spontaneous respirations.
If the patient have a IV in place, I would induce with lidocaine, glycopyrrolate, midazolam and Ketamine.
In either case, I would have emergency airway equipment in the room and a ENT doctor in a standby for an amazing tracheostomy if the airway is lost.
Problems with intubation:
Precautions while using a carbon dioxide laser:
Flammable surgical drapes should be minimize and wet towels should cover the face, neck, shoulder to absorb laser energy. The eyes should be protected with shield or moist gauze pads. Safety glasses should be worn by operating room personnel. Fio2 should be as low posible and nitrous oxide must not be used.
Laser safety ETT with saline filled cuff, fire extinguisher, smoke evacuator, especially masks to prevent the spread of virus upon vaporization
Airway Fire
Call for help, stop the flow of oxygen, disconnect the ETT from the gas source, and immediately extubate, ensuring that the entire ETT has been removed. A chest x-ray and a bronchoscopy should be performed to determine the extent of injury.
Postop:
If mild edema:
After resecuring the airway with a smaller size ETT, I would continue with conservative measures by monitoring and giving humidified oxygen, steroids, and racemic epinephrine
