Evolution of anaesthesia technique for endolaryngeal surgery through and post-COVID-19 pandemic: An experience from a tertiary referral centre for airway surgery.

Background and Aims: Anaesthesia for endolaryngeal surgery is specialised to provide almost a tubeless surgical field. During the coronavirus disease-19 pandemic, when most of the surgeries were staggered, we being in a tertiary referral centre for airway surgery had to modify our existing techniques and observed an evolution in the anaesthesia management which we could continue even in the postpandemic period. Hence, we conducted this retrospective study to analyse the reliability of our locally developed apnoeic high-flow oxygenation technique (AHFO) for endolaryngeal procedures. Methods: We conducted this single-centric retrospective study from January 2020 to August 2021 to observe the choice of airway management techniques in endolaryngeal surgery and assess the feasibility and safety of AHFO. We also intend to propose an algorithm for airway management. We calculated the percentages of all necessary parameters to denote the trend in change of practices roughly classifying the study period as prepandemic, pandemic and postpandemic. Results: A total of 413 patients were analysed in our study. The changing trend over preference of AHFO from prepandemic (72%) and dominance of AHFO (92.5%) in the postpandemic period are the most significant observations of our study with 17% patients needing conversion to tube in-tube out technique due to desaturation which is comparable to 14% in prepandemic period. Conclusion: The tubeless field provided by AHFO replaced the conventional airway management techniques. Our study demonstrates the safety and feasibility of AHFO for endolaryngeal surgeries. We also propose an algorithm for anaesthetists involved in laryngology unit.