Intermittent apnea and total intravenous anesthesia for microscopic laryngeal surgery.

Intermittent apnea with inhalational anesthesia has been reported to improve the visualization of the larynx but it has some disadvantages from inhalational anesthetics. The authors evaluated the use of total intravenous anesthesia instead of inhalation anesthesia in 30 patients undergoing microscopic laryngeal surgery. Anesthesia was started with propofol, fentanyl and cisatracurium. The patients were ventilated with 100% oxygen and the period of intermittent apnea, guided by pulse oximetry and end tidal carbon dioxide monitoring, was started by removal of the endotracheal tube. This technique provided a good visualization and immobile field for the operation. The average duration of apnea was 258 +/- 107 sec. The number of periods of apnea ranged from 1 to 4. A few patients showed some sympathetic responses to surgical stimuli. In conclusion, intermittent apnea with total intravenous anesthesia, with appropriate precaution, could be used without any serious adverse outcome for microscopic laryngeal surgery.