Respiratory Efficacy of Subglottic Low-Frequency, Subglottic Combined-Frequency, and Supraglottic Combined-Frequency Jet Ventilation During Microlaryngeal Surgery

Competition between otolaryngologists and anesthesiologists for the limited space of the airway results in compromised control for both concerns. The surgeon desires an unobstructed view, whereas the anesthesiologist must ensure adequate ventilation. The drawbacks of standard methods include inadequate airways, inadequate visualization, and operating room contamination from inspired gases. Since 1984, we have developed a technique utilizing jet ventilation delivered through a metal delivery system providing a relatively safe, ignition-free environment. A total intravenous anesthetic technique is used to avoid any environmental contamination. The newer short acting, high potency narcotic, sufentanil citrate, combined with a short acting muscle relaxant, atracurium besylate or vecuronium bromide, have made this technique an ideal one for our needs. The pulse oximeter provides an invaluable margin of safety. This technique has been employed in 36 microlaryngeal procedures performed on 21 patients with a uniformly smooth perioperative course and only one complication. The technique, possible pitfalls, and applications are discussed.

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Low Frequency Oscillatory Ventilation through the Suction Channel of a Pediatric Bronchoscope

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909800403 ◽

1989 ◽

Vol 98 (4) ◽

pp. 251-255 ◽

Cited By ~ 7

Author(s):

Jacob Nutman ◽

Waldemar A. Carlo ◽

Robert L. Chatburn

Keyword(s):

Premature Infants ◽

Low Frequency ◽

Lung Model ◽

Jet Ventilation ◽

Air Trapping ◽

Similar System ◽

Single Interface ◽

Oscillatory Ventilation ◽

Residual Capacity

To determine whether low frequency oscillatory ventilation (LFOV) may be safely applied through the suction channel of a pediatric fiberoptic bronchoscope, we devised a system using a combination of jet ventilation and constant air suction, both delivered with a single interface valve. The system was tested on an in vitro lung model and on rabbits. With tidal volumes of 12 mL, inadvertent increase in functional residual capacity (FRC) measured in the lung model was minimal. All rabbits experienced marked hypoventilation (PaCO2 62 ± 2 torr) on introduction of the bronchoscope, which promptly improved with administration of LFOV (PaCO2 41 ± 4 torr). That baseline FRC remained stable indicated that air trapping did not occur. We conclude that LFOV improves ventilation in rabbits during bronchoscopy without causing air trapping. A similar system might be applied during bronchoscopy in full-term and premature infants, thus facilitating safer and more complete visualization of their airways and preserving the possibility of obtaining samples by suction.

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Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

The Laryngoscope ◽

10.1002/lary.1994.104.s65.1 ◽

1994 ◽

Vol 104 (S65) ◽

pp. 1-30 ◽

Cited By ~ 70

Author(s):

Darrell H. Hunsaker

Keyword(s):

Jet Ventilation ◽

Microlaryngeal Surgery

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Complications of Venturi Jet Ventilation During Microlaryngeal Surgery

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1985.00800040091014 ◽

1985 ◽

Vol 111 (2) ◽

pp. 127-131 ◽

Cited By ~ 54

Author(s):

T. J. O'Sullivan ◽

G. B. Healy

Keyword(s):

Jet Ventilation ◽

Microlaryngeal Surgery

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Jet Ventilation in the Pregnant Patient with Airway Stenosis: Surgical Safety and Outcomes

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419896598 ◽

2019 ◽

Vol 129 (5) ◽

pp. 489-493 ◽

Cited By ~ 1

Author(s):

Philip D. Heichel ◽

Christian P. Jacobsen ◽

Luis L. Llamas ◽

C. Blake Simpson ◽

David G. Lott ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Surgical Intervention ◽

Low Frequency ◽

Pregnant Patient ◽

Good Health ◽

Jet Ventilation ◽

Level Of Evidence ◽

Airway Stenosis ◽

Surgical Safety ◽

History Of

Objective: To review pregnancy outcomes and the safety of jet ventilation use in the gravid patient undergoing surgical airway intervention. Methods: A multi-institutional retrospective review of medical records was performed to identify women who underwent low-frequency jet ventilation during pregnancy for surgical treatment of airway stenosis. Postoperative complications were noted, and patients were interviewed regarding pregnancy outcomes. Results: Six women were included in this series. No immediate complications relating to anesthesia or surgical intervention were noted in five of the six women. One patient with a well-known history of uncontrolled seizures experienced seizure activity postoperatively. One patient returned to the operating room at a later date for debridement of tracheal crusts. Five mothers delivered via cesarean section and one via spontaneous vaginal delivery. The mean gestation age was 37.3 weeks. One of the six infants delivered prematurely and three were delivered at low birth weight. Three of the six infants required elevated care immediately post-delivery but, at present, all are in good health. Conclusion: Low-frequency jet ventilation and surgical management of airway stenosis should be recognized as a safe treatment option in the gravid patient. Surgical intervention should not be delayed in patients with severe symptoms, particularly given the potential risk associated with prolonged corticosteroid use. Level of evidence: 4

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