[Development of anaesthetic technique for endolaryngeal surgery 1960--1976 (author's transl)].

Abstract

In 1960 direct laryngoscopy in combination with general anaesthesia with relaxation and intermittent positive negative pressure ventilation via a smallbore blocker tube was introduced. When, in 1965, microlaryngoscopy was developed it was exclusively performed with this technique. Since 1960, 44, 464 ear, nose or throat operations were carried out. 3,305 (7.4%) were endolaryngeal operations. 943 of them were performed in surface analgesia. 2,363 microlaryngoscopic operations were done under general anaesthesia. 22.5 per cent of the patients were women and 77.5 per cent were men. Their age varied between 6 weeks and 86 years. 2.4 per cent were children under 6 years of age and 33 per cent were aged over 60 years. The main advantages of this method over "open laryngeal surgery" are: 1. it provides a large measure of safety for the patient since even old and obese persons with a rigid rib cage can be adequately ventilated; the cuff prevents aspiration; there is no danger of the patient waking up during relaxation since he is being kept ventilated with a mixture of nitrous oxide-oxygen and halothane. Ventilation via the blocker tube begins immediately after intubation and not, as in open jet ventilation, after insertion of the laryngoscope. 2. The surgeon and his team are not exposed to the risk of infection since, in contrast to the "open larynx" methods, the closed system effectively prevents the escape of pathogenic micro-organisms.