Anesthesia for CO2 laser surgery of the larynx.

The CO2 laser is a useful surgical tool in laryngology, but adds a significant anesthetic risk because of a constant fear of fire. This paper reviews the anesthetic problems of laryngology in general - competition for the airway between surgeon and anesthetist, circulatory changes associated with laryngoscopy, and postoperative laryngospasm and edema, as well as operating room pollution together with problems unique to laser usage. If endotracheal tubes are used, they may burn, the laser may be misaligned, endotracheal cuffs may burst, and there is a constant risk of a flash fire. The techniques favored are either a small born endotracheal tube wrapped in aluminum foil or an injection technique. The former may obstruct laryngeal lesions. The injection technique is described in detail together with the pharmacological management of anesthesia.