Anesthetic Management for Laser Excision of Ball-Valving Laryngeal Masses

Benjamin B Bruins; Natasha Mirza; Ernest Gomez; Joshua H Atkins

doi:10.1155/2015/875053

Anesthetic Management for Laser Excision of Ball-Valving Laryngeal Masses

Case Rep Anesthesiol. 2015:2015:875053. doi: 10.1155/2015/875053. Epub 2015 May 24.

Authors

Benjamin B Bruins¹, Natasha Mirza², Ernest Gomez³, Joshua H Atkins⁴

Affiliations

¹ Department of Anesthesiology & Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
² Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, USA.
³ Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
⁴ Department of Anesthesiology & Critical Care, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, The University of Pennsylvania, PA 19104, USA.

Abstract

A 47-year-old obese woman with GERD and COPD presents for CO2-laser excision of bilateral vocal fold masses. She had a history of progressive hoarseness and difficulty in breathing. Nasopharyngeal laryngoscopy revealed large, mobile, bilateral vocal cord polyps that demonstrated dynamic occlusion of the glottis. We describe the airway and anesthetic management of this patient with a topicalized C-MAC video laryngoscopic intubation using a 4.5 mm Xomed Laser Shield II endotracheal tube. We examine the challenges of anesthetic management unique to the combined circumstances of a ball-valve lesion and the need for a narrow-bore laser compatible endotracheal tube.