Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-28T04:08:57.508Z Has data issue: false hasContentIssue false
  • English
  • Français

Anaesthesia for microlaryngeal and laser laryngeal surgery: impact of subglottic jet ventilation

Published online by Cambridge University Press:  06 January 2010

M Barakate ,
E Maver ,
G Wotherspoon  and
T Havas
M Barakate*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Auburn Hospital, Australia Department of Otolaryngology Head and Neck Surgery, Prince of Wales Private Hospital, Australia
E Maver
Affiliation:
Department of Anaesthesia, Prince of Wales and Sydney Children's Hospitals, The University of New South Wales, Randwick, Sydney, Australia
G Wotherspoon
Affiliation:
Department of Anaesthesia, Prince of Wales Private Hospital, Australia
T Havas
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Prince of Wales Private Hospital, Australia Department of Otolaryngology Head and Neck Surgery, Prince of Wales and Sydney Children's Hospitals, The University of New South Wales, Randwick, Sydney, Australia
*
Address for correspondence: Dr Michael Barakate, PO Box 340, Randwick 2031, NSW, Australia. E-mail: barakate@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Over the past 20 years, jet ventilation techniques have been developed to enable safe and controlled microlaryngoscopy and the accurate treatment of laryngeal pathology. This study examined how advances in jet ventilation tube design have facilitated safe endolaryngeal surgery.

Study design:

The study documented the development and use of the Jockjet subglottic jet ventilation tube system at the Prince of Wales Hospital, Sydney. The new system consisted of two components: a Teflon tube with an outer diameter of 4 mm at the larynx, and a companion ventilator. The facility for end-tidal carbon dioxide and distal airways pressure monitoring was incorporated via dedicated channels. The Venturi jet was produced via a covered tip to prevent trauma to the tracheal mucosa.

Setting:

The Prince of Wales and Sydney Children's Hospitals, incorporated with The University of New South Wales.

Patients:

From June 2002 to March 2008 inclusive, 1000 consecutive patients underwent microlaryngeal surgery at this institution. Subglottic jet ventilation, via the Jockjet tube, was employed for 332 patients.

Main outcome measures:

Anaesthetic safety and intra-operative surgical access.

Results:

In all the 332 patients observed, surgical access was optimised and no adverse anaesthetic outcomes were encountered.

Conclusion:

Subglottic jet ventilation facilitates safe airway management during microlaryngeal and laser laryngeal surgery.

Keywords

LarynxVentilationAnaesthesia
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 6 , June 2010 , pp. 641 - 645
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster at the Combined Otolaryngological Spring Meetings, 28–31 May 2009, Phoenix, Arizona, USA.

References

1 Sanders, RD. Two ventilating attachments for bronchoscopes. Delaware Med J 1967;39:170Google Scholar
2 Carden, E, Becker, G, Hamood, H. Percutaneous jet ventilation. Ann Otol Rhinol Laryngol 1976;85:652–5CrossRefGoogle ScholarPubMed
3 El-Naggar, M, Keh, E, Stemmers, A, Collins, VJ. Jet ventilation for microlaryngoscopic procedures: a further simplified technic. Anesth Analg 1974;53:797–804CrossRefGoogle ScholarPubMed
4 Komesaroff, D, McKie, B. The “bronchoflator”: a new technique for bronchoscopy under general anaesthesia. Br J Anaesth 1972;44:1057–68CrossRefGoogle ScholarPubMed
5 O'Sullivan, TJ, Healy, GB. Complications of Venturi jet ventilation during microlaryngeal surgery. Arch Otolaryngol 1985;111:127–31CrossRefGoogle ScholarPubMed
6 Ostfeld, E, Ovadia, L. Bilateral tension pneumothorax during pediatric bronchoscopy (high-frequency jet injection ventilation). Int J Pediatr Otorhinolaryngol 1984;7:301–4CrossRefGoogle ScholarPubMed
7 Craft, TM, Chambers, PH, Ward, ME, Goat, VA. Two cases of barotrauma associated with transtracheal jet ventilation. Br J Anaesth 1990;64:524–7CrossRefGoogle ScholarPubMed
8 Benjamin, B, Gronow, D. A new tube for microlaryngeal surgery. Anaesth Intensive Care 1979;7:258–63CrossRefGoogle ScholarPubMed
9 Hunsaker, DH. Anesthesia for microlaryngeal surgery: the case for subglottic jet ventilation. Laryngoscope 1994;104:1–30CrossRefGoogle ScholarPubMed
10 Bridger, GP, Maver, E. The Prince of Wales venturi jet system for safe microlaryngoscopy. Aust J Otolaryngol 2001;4:182–4Google Scholar
11 Davies, JM, Hillel, AD, Maronian, NC, Posner, KL. The Hunsaker Mon-Jet tube with jet ventilation is effective for microlaryngeal surgery. Can J Anaesth 2009;56:284–90CrossRefGoogle ScholarPubMed
12 Brooker, CR, Hunsaker, DH, Zimmerman, AA. A new anesthetic system for microlaryngeal surgery. Otolaryngol Head Neck Surg 1998;118:55–60CrossRefGoogle ScholarPubMed
13 Rakover, Y, Ben-Abraham, R, Avni, G, Nachtigal, D, Katz, Y. Use of the Benjet tube for operative laryngoscopy. Med Sci Monit 2003;9:PI51–3Google ScholarPubMed
14 Orloff, LA, Parhizkar, N, Ortiz, E. The Hunsaker Mon-Jet ventilation tube for microlaryngeal surgery: optimal laryngeal exposure. Ear Nose Throat J 2002;81:390–4CrossRefGoogle ScholarPubMed
15 Werkhaven, JA. Microlaryngoscopy-airway management with anaesthetic techniques for CO(2) laser. Paediatr Anaesth 2004;14:90–4CrossRefGoogle ScholarPubMed
16 Patel, A, Rubin, JS. The difficult airway: the use of subglottic jet ventilation for laryngeal surgery. Logoped Phoniatr Vocol 2008;33:22–4CrossRefGoogle ScholarPubMed
17 Havas, TE, Priestley, KJ. Laser tenotomy and vocal process resection for bilateral midline vocal fold fixation. Aust N Z J Surg 2003;73:326–30CrossRefGoogle ScholarPubMed
18 Hinni, ML, Salassa, JR, Grant, DG, Pearson, BW, Hayden, RE, Martin, A et al. Transoral laser microsurgery for advanced laryngeal cancer. Arch Otolaryngol Head Neck Surg 2007;133:1198–204CrossRefGoogle ScholarPubMed
19 Miyawaki, J, Shono, S, Katori, K, Sakuragi, T, Higa, K. Subglottic jet ventilation for pediatric microlaryngosurgery: a case report. J Clin Anesth 2003;15:363–5CrossRefGoogle ScholarPubMed
20 El Hammar-Vergnes, F, Cros, AM. High frequency jet ventilation in paediatric anaesthesia [in French]. Ann Fr Anesth Reanim 2003;22:671–5CrossRefGoogle ScholarPubMed
21 Remacle, M, Declaye, X, Mayne, A. Subglottic haemangioma in the infant: contribution by CO2 laser. J Laryngol Otol 1989;103:930–4CrossRefGoogle ScholarPubMed
22 Cook, TM, Alexaner, R. Major complications during anesthesia for elective laryngeal surgery in the UK: a national survey of the use of high-pressure source ventilation. Br J Anaesth 2008;101:266–72CrossRefGoogle Scholar