Anaesthesia for procedures on the larynx and pharynx. The use of the Bullard laryngoscope in conjunction with high frequency jet ventilation.

Abstract

Twenty patients undergoing elective procedures on the larynx and pharynx were anaesthetised using a propofol infusion and a bolus of vecuronium. High frequency jet ventilation was employed via a 7 French gauge catheter, with a second catheter being used to measure expired carbon dioxide levels. The Bullard laryngoscope was compared with the Macintosh instrument both for visualising the larynx and subsequently inserting a catheter. One catheter was left in place until the patient was fully awake, and in one case this enabled gas exchange to be maintained in the presence of laryngospasm. Using the Bullard laryngoscope, intubation was possible in all 20 patients, in a mean time of 22 (6.8) s. Using the Macintosh laryngoscope only 16 patients could be intubated and this took significantly longer at 34 (18.3) s (p < 0.05). The Bullard laryngoscope and high frequency jet ventilation offer a reliable method of intubating and anaesthetising patients with upper airways pathology and further benefits may accrue in the recovery period.