Microlaryngoscopy
Clinical Procedure
 
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Examination of the larynx with the use of a microscope. Direct (usually suspension) laryngoscopy is utilised to provide visual and instrument access to the laryngeal structures.

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Jan 02, 2013
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Dexamethasone may reduce risk of swelling and airway obstruction

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Nov 06, 2011
Dose to reduce airway swelling is 0.4mg/kg, max dose 8mg #ref
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Anaesthetise cords with topical local anaesthetic to minimise risk of laryngospasm

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May 18, 2011
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If surgeon is performing biopsy (particularly of suspected tumour), lesion may bleed and contaminate airway. MLT tube may protect the distal airway from blood better than supraglottic jet ventilation

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Aug 06, 2011
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If the lesion is posterior, a microlaryngoscopy tube will usually obstruct the view, so will likely require supraglottic or subglottic jet ventilation.

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Dec 04, 2012
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Benjet subglottic ventilation refl.in/2r

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Sep 25, 2016
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Children will tolerate the suspension laryngoscopy at lower depths of anaesthesia than adults. They are therefore generally suitable for a spontaneosly ventilating technique with propofol TIVA. Insert a nasal cannula with tip sitting in nasopharynx delivering oxygen. Opioid titrated or infused to effect.

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Oct 03, 2011
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Rigid suspension laryngoscope will be used. Monitor to ensure safe neck extension by surgeon

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May 18, 2011
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Rigid laryngoscopy will be very stimulating. Ensure adequate analgesia (short acting opioid such as fentanil/alfentanil) is on board at time of procedure

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Nov 08, 2012
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If the infant/child has a nasogastric tube insitu, aspirate this prior to induction to empty the stomach as much as possible.

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Oct 14, 2011
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If draining a supraglottic mucocoele/laryngocoele where obstruction is a concern:

Gas induction, insert a shortened nasal ETT that ends in the oropharynx, connect to T-piece, test ventilate by closing mouth, maintain spont ventilation on propofol infusion, allow surgeons to perform microlaryngoscopy, drain cyst, and perform rigid bronchoscopy.

Insert ETT after this for the full marsupialisation of the cyst.

If worried about oedema developing, keep ventilated for 20min and reassess for swelling prior to sending to ICU either intubated or extubated.

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Sep 29, 2013
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Subglottic jet ventilation with laser-safe, Hunsaker Mon-Jet ventilation tube.

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Mar 12, 2012
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