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Intermittent Apnea and Total Intravenous Anesthesia for


Thewarug Werawatganon MD, MSc*,
Pakpoom Supiyaphun MD**, Virachai Kerekhanjanarong MD**,
Oraluxna Rodanant MD*, Pronarun Sirichotewithayakorn MD*
* Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University
** Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University


Intermittent apnea with inhalational anesthesia has been reported to improve the visualization of
the larynx but it has some disadvantages from inhalational anesthetics. The authors evaluated the use of
total intravenous anesthesia instead of inhalation anesthesia in 30 patients undergoing microscopic laryngeal
surgery. Anesthesia was started with propofol, fentanyl and cisatracurium. The patients were ventilated with
100% oxygen and the period of intermittent apnea, guided by pulse oximetry and end tidal carbon dioxide
monitoring, was started by removal of the endotracheal tube. This technique provided a good visualization
and immobile field for the operation. The average duration of apnea was 258 + 107 sec. The number of
periods of apnea ranged from 1 to 4. A few patients showed some sympathetic responses to surgical stimuli.
In conclusion, intermittent apnea with total intravenous anesthesia, with appropriate precaution, could be
used without any serious adverse outcome for microscopic laryngeal surgery.

Keyword : Intravenous anesthesia, Intermittent, Apnea, Laryngeal surgery

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