TUBELESS FIELD IN PEDIATRIC LARYNGEAL PAPILLOMATOSIS SURGERIES AT TERTIARY CARE CENTER: ANESTHETIC MANAGEMENT

Abstract

Recurrent respiratory papillomatosis (RRP) is a benign disease caused by human papilloma virus. It occurs frequently in children under 10 years of age, though it affects entire airway common sites are the anterior commissure, subglottic and epiglottis. Among different modalities of treatment microdebrider has gained popularity because it allows precise debridement and selective suctioning of the affected tissue, limiting scarring, limiting injury to laryngeal structure with shorter operating time and absence of thermal injury.
Sharing of airway by surgeon and anesthesiologist is a challenge for respiratory papillomatosis surgeries. Tubeless field can be provided by both inhalation agents and total intravenous agents. Complete occlusion of larynx with inability to ventilate, difficulty in intubation, laryngospasm, aspiration, inadequate depth of anesthesia, hypercapnia during apneic oxygenation, hypoxia, airway edema, increase airway secretion, multiple exposure to anesthesia are the anesthetic concern during surgery. Smooth and better outcome during removal of recurrent respiratory papillomatosis without intubation has been possible with proper planning, good coordination and communication among anesthesia team, surgical team, nursing staffs and flexibility in decision making.

Keywords: Laryngeal papillomatosis, Pediatric, Tubeless