Laryngoscopy

Goldman, Joseph L.; Talbot, Harry

doi:10.1016/s0039-6109(16)35289-6

Cited by 3 publications

(6 citation statements)

References 4 publications

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“…For this tube to be laser compatible, a new highly flame-resistant material needed to be used. Several authors have commented that flexible tubes need to be made of a different kind of plastic than presently available.11 6 Teflon is the plastic used in the kitchen which is most resistant to heat. It is used in industry for safety coatings of fire alarm cable, electric arc quenching equipment, and other components that may be exposed to great changes in temperature.…”

Section: Laser-safe Tubementioning

confidence: 99%

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Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Hunsaker

1994

The Laryngoscope

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Although the techniques for surgery on the endolarynxusing suspension and the operating microscope have been fully developed,1–4 the safest, and least obtrusive anesthetic technique has yet to be manifested, as evidenced by more than 200 references to anesthesia for microlaryngoscopy in the world literature. This study reviews the physiology, physics, and problems of each anesthetic technique. In light of this review, animal and human studies are reported demonstrating the utility and safety of subglottic ventilation when provided with proper monitoring using an automatic ventilator. A modified Ben‐Jet tube is reported,5 which has a 1‐mm ID channel to monitor Pco2 and tracheal pressure. This self‐centering 3.0‐mm tube, which extends 6 to 8 cm below the glottis, is unobtrusive for the surgeon. The subglottic tube, which is much less likely to be malaligned, is much more acceptable to the anesthesiologist. Anesthesia, by intravenous sedation, utilizes neuromuscular blockade while ventilating through the jet tube powered by an automatic ventilator with an automatic shutdown feature attached to the monitor tube to prevent inadvertent barotrauma. The third phase of this study compared fluoroplastic, used in a prototype jet ventilation tube, with 6‐mm Silastic®, Red Rubber, and polyvinyl chloride (PVC) tubes when struck by maximum power of CO2, Nd‐YAG, and K‐532 lasers. The test was performed in a closed chamber in which concentrations of oxygen and nitrogen were controlled. Although damaged by the CO, laser beam, the fluoroplastic tubes did not continue burning when the laser was turned off in 100% oxygen, even when coated by blood. The other three tubes continued to burn in 23% oxygen. Neither the KTP nor Nd‐YAG laser damaged the Teflon tube, while they ignited a sustained flame in 30% oxygen. This study supports the use of fluoroplastic for a laser safe jet ventilation tube. It also demonstrates the danger of tube fires, even in low oxygen concentrations, when using Silastic, rubber, and PVC tubes in laser laryngeal surgery. There was no difference in the flammability of Silastic, rubber or PVC when struck by these lasers in this study. For these reasons, subglottic ventilation using a fluoroplastic, monitored, self‐centering, subglottic, jet ventilation tube driven by an automatic ventilator with a shutdown feature, in the event of excessive pressure buildup, is proposed for anesthetizing healthy patients undergoing suspension microlaryngoscopy, and who have no airway obstructing lesion. A large tube with inflatable cuff is indicated when a supraglottic lesion may obstruct the airway.

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Section: Laser-safe Tubementioning

confidence: 99%

“…Since laryngoscopy was developed by Desmoreaux in 1853, 6 many techniques have been used to render the patient free of pain and amnestic to the experience of laryngoscopy. There appears to be no universally acceptable anesthetic technique, as evidenced by over 200 reports concerning anesthesia for laryngoscopy.…”

Section: Introductionmentioning

confidence: 99%

Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Hunsaker

1994

The Laryngoscope

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“…3 The airway has been shared by the anesthesiologist and the laryngologist for more than a century. However, the development of an ideal anesthetic system for laryngoscopy has been somewhat elusive; the needs of the anesthesiologist and the laryngologist vary considerably.…”

Section: Introductionmentioning

confidence: 99%

Subglottic Jet Ventilation for Suspension Microlaryngoscopy

Rubin

Patel

Lennox³

2005

Journal of Voice

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“…This search is indicated by more than 200 references to anesthesia for microlaryngoscopy in the world literature. 1,2 The development of an ideal anesthetic system for microlaryngeal surgery has not been successful in satisfying both the surgeon and the anesthesiologist. Ideally, the surgeon would have an endotracheal tube that does not obstruct surgical visualization, impede surgical manipulation, move the vocal cords, or allow blood, tissue, or laser flumes to enter the bronchi.…”

Section: Since the Introduction Of Laryngoscopy Bymentioning

confidence: 99%

“…Since the introduction of laryngoscopy by Desmoreaux 1 in 1853 and of suspension microlaryngeal surgery some 30 years ago, the safest and least obtrusive anesthetic technique for microlaryngeal surgery has yet to be found. This search is indicated by more than 200 references to anesthesia for microlaryngoscopy in the world literature 1,2 .…”

mentioning

confidence: 99%

A New Anesthetic System for Microlaryngeal Surgery

Brooker

Hunsaker²,

Zimmerman³

1998

Otolaryngol.--head neck surg.

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Anesthesia for microlaryngeal surgery creates many obstacles for the anesthesiologist and otolaryngologist. Anesthetic techniques developed to improve surgical exposure have been met with significant limitations and are difficult for the anesthesiologist to monitor. A new subglottic jet ventilation anesthesia system is introduced that meets the needs of the otolaryngologist and the anesthesiologist. This new system is made up of two components: (1) The Hunsaker Mon-Jet tube is a laser-safe, subglottic jet ventilation tube constructed of a nonflammable fluoroplastic material. It allows monitoring of tracheal pressure and end tidal carbon dioxide, and it is designed with a basket-shaped distal extension to align the jet port away from the tracheal mucosa and to prevent trauma and submucosal injection of jetted gas. (2) An automatic jet ventilator, which has an adjustable respiratory rate, inspiratory/expiratory ratio, and flow rate, also monitors expiratory end peak airway pressures and has an automatic shutdown feature if either of these pressures are exceeded. This system was successfully used in 36 patients undergoing microlaryngeal surgery.

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Laryngoscopy

Cited by 3 publications

References 4 publications

Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Subglottic Jet Ventilation for Suspension Microlaryngoscopy

A New Anesthetic System for Microlaryngeal Surgery

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