Inhalation Insufflation Technique with Local Anaesthetic Spray without Intubation and Opioids for Paediatric Upper Airway Surgery - Observational Case Series Study

Anaesthetic management of upper airway surgery in paediatric is challenging. Total intravenous anaesthesia with opioid or inhalation technique with spontaneous respiration has been used but studies are limited on inhalation technique. This study aimed to use tubeless inhalation insufflation technique without opioids at a tertiary centre. All paediatric patients coming for elective upper airway surgery to the centre, were included. Mask induction was with 5-8% sevoflurane in O2 and maintenance with 2-3%, via a nasopharyngeally placed Endotracheal Tube (ETT) or catheter on spontaneous ventilation with flow between 8-10 l/min. Lidocaine up to 5 mg/kg was then sprayed to the mucosa of larynx and trachea. Once adequate depth was attained, suspension laryngoscope was placed by a surgeon for surgery. Some complications were observed i.e inadequate anaesthesia requiring rescue drugs like opioids or propofol, intubation, desaturation events from laryngospasm and delayed recovery. Surgical technique involved was diagnostic and therapeutic for the upper airway lesions. Fifteen paediatric patients (2 months to 7 yrs) were included in the study with tubeless anaesthesia. None of them required intubation during the procedure. The mean time from induction of anaesthesia to unconsciousness was 15 ± 3 s and attainment of necessary anaesthetic depth for surgery was 4.7 ± 0.90 min. None had desaturation events or required opioids. However, propofol was required in one and delayed anaesthetic recovery was observed in one patient. This study on tubeless anaesthesia with Local Anaesthetic (LA) spray with spontaneous inhalation insufflation technique provided an opioid-free, interference-free operative field without airway compromise, not requiring intubation, therefore, further studies are required.