Anästhesiologische Besonderheiten bei der laryngotrachealen Chirurgie

Abstract

During surgical procedures of the upper respiratory tract anesthesiologists and surgeons are in a kind of competition situation because of the close spatial relationship between the airway of the patient and the surgical area. Especially in laryngeal surgery the use of high-frequency jet ventilation (HFJV) offers an alternative to the endotracheal tube. During HFJV the ventilation gas is intermittently administered by an injector with a high frequency into the airway which is open to the outside. Exhalation occurs passively in the area nearby the wall of the airway cross-section. According to the availability of the technique and the indications jet ventilation can be implemented in an infraglottic, supraglottic, transtracheal or transluminal manner. To exert influence on gas exchange of the patient the respiratory rate, driving pressure, oxygen concentration and inspiration time can be changed according to the needs. Severe tracheal stenosis, risk of excessive bleeding during the procedure, patients at risk for aspiration and exacerbation of lung diseases are depicted as contraindications for HFJV. Complications under HFJV are rare despite the limited conditions for monitoring gas exchange and mechanics of ventilation in contrast to conventional ventilation. A particular challenge for the anesthesiologist is the use of HFJV during laryngeal laser surgery.

Supraglottic jet oxygenation and ventilation assisted fiberoptic intubation in a paralyzed patient with morbid obesity and obstructive sleep apnea: a case report

“…The pathological difficult airway usually place patients in danger during general anesthesia induction [1], which may result in a high percentage of airway-related morbidity and mortality [2, 3]. Hypoxia is a major concern and cause of morbidity or mortality during tracheal intubation after anesthesia induction in a pathological obese patient with obstructive sleep apnea (OSA) [4–6].…”

Assessment of changes of regional ventilation distribution in the lung tissue depending on the driving pressure applied during high frequency jet ventilation

“…High frequency jet ventilation (HFJV) is a time cycled, pressure limited mode of ventilation that facilitate gas exchange by utilizing smaller tidal volumes from a high pressure at supraphysiologic frequencies between 120 and 400 min − 1 followed by a passive expiration [ 1 ]. HFJV offers the advantage of sufficient ventilation of patients lung’s and simultaneous low motion of the patients airway including the vocal cords.…”