Percutaneous transtracheal jet ventilation for paediatric endoscopic laser treatment of laryngeal and subglottic lesions

Objective: To describe our experience with superimposed high-frequency jet ventilation (SHFJV), which does not require any endotracheal tubes or catheters, for performing laryngeal and tracheal surgery.Design: A case series of 500 patients.Setting: A university medical center.Patients: Four hundred sixty adult patients and 40 children in a consecutive sample who required laryngeal or tracheal surgery under SHFJV.Interventions: The SHFJV uses 2 jet streams with different frequencies simultaneously and is applied using a jet laryngoscope. Ventilation was performed with an airoxygen mixture, and intravenous agents were used for anesthesia. Arterial blood gas values were analyzed. Main Outcome Measures:Reported values of oxygenation and ventilation during the application of SHFJV and laryngotracheal surgery.Results: In 497 patients, adequate oxygenation with a mean ± SD PaO 2 of 91.8 ± 22.9 mm Hg and ventilation with a PaCO 2 of 29.7 ± 5.5 mm Hg were achieved using SHFJV. The average duration of the application of ventilation was 27 minutes, and the longest duration was 118 minutes. No complications due to the ventilation technique were observed. Laser surgery was performed in 150 patients.

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“…Subglottic jet techniques applied through the larynx 6,7 or percutaneously through the trachea 8 with thin…”

Section: Commentmentioning

confidence: 99%

Superimposed High-Frequency Jet Ventilation for Laryngeal and Tracheal Surgery

Lanzenberger-Schragl

Donner²,

Grasl³

et al. 2000

Arch Otolaryngol Head Neck Surg

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“…The technique is performed by inserting an 18G radiopaque Teflon catheter mounted on a stainless steel needle through the cricothyroid membrane, under direct vision via a rigid telescope and camera system. This technique is described in 28 paediatric patients with three serious complications [15]. One case of extensive surgical emphysema with pneumoperitoneum and pneumomediastinum, one case of bilateral pneumothoraces requiring bilateral chest drains and one case of severe vagus-induced cardiac depression which was attributed to vagal stimulation during positioning of the microlaryngoscopy blade We, therefore, feel that our nasopharyngeal technique offers a lower risk of morbidity.…”

Section: Discussionmentioning

confidence: 93%

A tubeless anaesthetic technique for paediatric laryngeal laser surgery

Richards

Kaushik

Rothera

et al. 2005

International Journal of Pediatric Otorhinolaryngology

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“…In experienced hands, this technique is almost free of complications, is minimally invasive, and usually allows discharge after 2 days. 11,12 The CO 2 laser has also been used with success and without complications in cases of laryngomalacia, 11 subtotal arytenoidectomy especially in adults, 13 and infantile subglottic hemangioma. 14 In chronic cases, the inflammatory lesion of idiopathic subglottic stenosis responds to corticosteroids, but steroid dependence seems to be the rule.…”

Section: Discussionmentioning

confidence: 98%