Paediatric Anaesthesia Department

Anaesthesia For Laser Surgery

1. Diseases

Multiple papillomatosis
Laryngeal or upper airway masses
Laryngeal malformations

2. Anaesthetic problems

Shared airway
Potential airway obstruction and hypoxaemia
Potential for burns to airway, eyes, face
Hazard to staff : infection from plume, eye damage from laser

3. Assessment

Careful assessment of airway and potential for obstruction
ETT is rarely needed, paediatric metal tubes are available
Consultation with surgeon

4. Preparation of patient

Paracetamol 20mg/kg for premedication

5. Preparation of theatre

As for elective surgery PLUS
Equipment for patient protection
ointment for eyes plus eye pads and wet gauze
wet drapes
individual malleable plastic guard for the teeth
jug iced water available
Modified Downs Mackintosh Anaesthetic Spray with Lignocaine diluted to limit dose to 4mg/kg

6. Induction

Inhalational or I.V.as indicated
gain i.v. access
apply topical lignocaine spray to pharynx, larynx and trachea
apply eye protection
Monitoring- pulse oximetry, ECG, NIBP, FIO2, hand on abdomen

7. Maintenance

Spontaneous ventilation under deep halothane or propofol infusion
O2/N2O with Ayre's T-piece and mask until the suspension laryngoscope is inserted then insufflation
We do not dilute with nitrogen becuse we do not have a flammable tube in the airway
depth of anaesthesia with halothane may be increased by occluding the inlet of the suspension laryngoscope with a gauze swab.
give analgesia- paracetamol PR 25mg/kg

8. Homeostasis

Guided by monitoring, IV fluids not routine

9. Emergence

Remove suspension laryngoscope while deep
Apply Ayre's T-piece and mask with 100% O2

9. Recovery

Routine observations for patient who has been intubated
Return to ward when consciousness regained, observations stable

10. Post-operative management

Nil orally for 1 hours post lignocaine spray
Analgesia- paracetamol PO/PR

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