Intraoperative Complications of Endoscopic Upper Airway Laser Surgery in Kasr Al-Ainy Hospital: A Prospective Study

Background: Laser surgery of the upper airway is performed endoscopically under the microscope. The functional results are better than those performed by an open partial technique and most patients do not require a tracheotomy. Shared airway procedures are unique in that both anesthetist and surgeon are working in the same anatomical field. The aim of this study was to evaluate the incidence, type and clinical significance of intraoperative complications of upper airway lesions treated with laser surgery. Patients and Methods: Following approval of departmental ethics and research committee and obtaining written informed consent, sixty-six patients undergoing endoscopic airway laser surgery starting from January 2012 to December 2012 were included in the study. These patients were examined by the ENT consultant, diagnosed as having any airway pathology indicated for endoscopic airway laser surgery and scheduled for surgical management. Routine investigations were performed preoperatively in addition to specific investigations related to the pathology including chest X-ray, indirect laryngoscopy and arterial blood gases in addition to meticulous assessment of the airway. Patients with severe stridor, tracheo-stomised patients and patients with history of any previous anesthetic complications were excluded. Intraoperative standard monitoring was performed, followed by induction in the presence of all equipments for difficult airway managment. Safety features for laser surgery were taken regarding the patient and medical personnel. Anesthesia was maintained and the patients were monitored for HR, BP, SaO2, EtCO2 and the intraoperative complications related to airway management, anesthetic management and surgical management. Results: Intraoperative complications included difficult intubation (24%). These were due to anatomical variations of airway “representing 18% including short neck, short thyromental distance, Mallampti III or others”. Lesions leading to distortion of the airway comprised (6%), difficult ventilation (23%), cuff perforation (3%), airway bleeding (5%), airway fire (3%), surgical emphysema (2%) and pneumothorax (2%). Conclusion: In conclusion, it could be said that the rate of complications related to laser surgery is low, but sometimes the anesthetist has to deal with complications of different types such as ignition, bleeding or respiratory distress.