Helium insufflation with sevoflurane general anesthesia and spontaneous ventilation during airway surgery

Abstract

Purpose The therapeutic benefits and clinical applications of helium-oxygen gas mixtures were first reported over 70 years ago. Since then, helium has been used in the treatment of obstructive processes of both the upper and lower airways. We report a unique case regarding helium insufflation with sevoflurane anesthesia and spontaneous ventilation for airway surgery. Clinical features A helium-oxygen mixture was administered during airway surgery in an 8-year-old boy with obstruction of the upper airway. Following the introduction of a helium-oxygen mixture during general anesthesia with spontaneous ventilation, a relatively rapid improvement in the patient's respiratory status was observed with a decrease in the audible inspiratory stridor, improved gas exchange, decreased respiratory rate, decreased suprasternal/intercostal retractions, and a decrease in the transcutaneous CO 2 . The physiologic basis for helium's effects on gas exchange are discussed and its use during insufflation for upper airway surgery is reviewed. Conclusions The addition of helium improves gas exchange with spontaneous ventilation during general anesthesia for airway surgery. RésuméObjectif Les bienfaits the´rapeutiques et les applications cliniques des me´langes gazeux he´lium-oxyge`ne ont e´te´r apporte´s pour la premie`re fois il y a plus de 70 ans. Depuis, l'he´lium a e´te´utilise´dans le traitement de syndromes obstructifs des voies ae´riennes supe´rieures et infe´rieures. Nous rapportons ici un cas unique en ce qui touche a`l'insufflation d'he´lium lors d'une anesthe´sie au se´voflurance en ventilation spontane´e lors d'une chirurgie des voies ae´riennes. É léments Cliniques Un me´lange he´lium-oxyge`ne a e´teá dministre´pendant une chirurgie des voies ae´riennes re´alise´e chez un enfant de huit ans manifestant une obstruction des voies ae´riennes supe´rieures. Apre`s l'introduction d'un me´lange he´lium-oxyge`ne pendant l'anesthe´sie ge´ne´rale avec ventilation spontane´e, une ame´lioration relativement rapide de l'e´tat respiratoire du patient a e´te´observe´e avec une diminution du stridor audible, un e´change gazeux ame´liore´, une fre´quence respiratoire re´duite, un tirage suprasternal/intercostal moindre et une re´duction du CO 2 transcutane´. Le fondement physiologique des effets de l'he´lium sur les e´changes gazeux est discute´et son utilisation pendant l'insufflation lors de chirurgie des voies ae´riennes supe´rieures est passe´e en revue. Conclusion L'ajout d'he´lium ame´liore les e´changes gazeux en ventilation spontane´e pendant l'anesthe´sie ge´ne´rale lors de chirurgies des voies ae´riennes.

Perioperative Care of an Infant With an Open Safety Pin in the Hypopharynx

“…Nitrous oxide also dilutes the inspired oxygen concentration thereby providing less time if effective ventilation is lost. If available, helium may be used to decrease gas density, increase flow and speed anesthetic induction in patients with a compromised airway and decreased minute ventilation [17,18]. In the majority of cases, anesthesia is maintained with the insufflation of sevoflurane via the operating laryngoscope, although others have described the use of various intravenous anesthetic agents including remifentanil, propofol and dexmedetomidine [15,19,20].…”

Anesthesia for thoracic surgery in infants and children

“…[ 100 ] This may be countered through bronchoscopy through a laryngeal mask airway or by the administration of helium along with oxygen, as the lower density of helium allows for decreased resistance to air movement. [ 19 101 ] Although rigid bronchoscopes do offer a means for ventilation through the hollow interior, the turbulent nature of flow through the bronchoscope significantly increases resistance in comparison to an ETT of a similar diameter. [ 102 ]…”

General Anesthesia with Preserved Spontaneous Breathing through an Intubation Tube

“…По данным литературы, увеличение времени вдоха и инверсия соотношения вдох выдох могут открыть не вентилируемые участки легких [35]. Также они могут быть расправлены при помощи маневра рекрутмента [31,33].…”