A chest-lung model, consisting of a human laryngo-tracheo-bronchial tree cast (4 or 5 bronchial generations) tightly enclosed in a 100 l rigid box was used to assess the potential efficiency of high frequency jet ventilation in patients with upper tracheal stenosis. The elasticity of the air in the box stimulated normal adult chest-lung compliance. Diaphragms (0.5 or 1.5 cm thick) were inserted into the upper trachea to simulate stenoses of 0.7, 1, 1.5 and 1.75 cm inner diameter. A rigid injector-catheter (5 mm outside diameter) was directed in the axis of the trachea with its tip 2.5 cm beneath the stenosis. The end inspiratory alveolar pressure (PA), the end expiratory pressure (PEEP) and the tidal volume (VT) were measured at a rate of 100/min and 30% inspiratory to total periods ratio. Entrained flow, Vem, measured at the start of air insufflation, was compared to that calculated (Vec) from a simple model. For a given setting of the ventilator, PEEP, PA--PEEP and VT were approximately linearly related to the difference in diameters of stenosis and injector. While PEEP decreased, both PA--PEEP and VT increased with increasing diameter of stenosis. When the diameter of the stenosis was higher than 1.5 cm no changes in PA--PEEP and VT were observed, owing to the narrowest section of the larynx. Vec was always higher than Vem. The thickness of the stenosis did not affect the results, and the diameter of the stenosis appeared to be the main factor affecting the ventilatory parameters under our experimental conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

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Summary Adenoidectomy in paediatric outpatient surgery is assumed to require tracheal intubation (TT). The laryngeal mask airway (LMA) commonly used for general paediatric surgery has never been previously studied for adenoidectomy. We therefore prospectively compared in a randomized manner, the incidence of complications with TT and LMA in 56 children undergoing adenoidectomy. Preoperative, intraoperative and the lowest SPO2 values after removal of either TT or LMA were recorded. The respiratory complications, cough, stridor and/or laryngospasm, were recorded intraoperatively and after removal of the airway device. The oxygen saturation levels were significantly higher in the laryngeal mask airway group both intraoperatively and after removal of the respiratory device (P<0.05). The incidence of respiratory complications was lower in the LMA group. In conclusion we have shown that the laryngeal mask airway with a flexometallic tube is a satisfactory alternative to tracheal intubation for outpatient paediatric adenoidectomy.

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