Proximal Large-Bore Jet Ventilation for Laryngeal Laser Surgery

Koufman, James A.; Little, Frank B.; Weeks, Duke B.

doi:10.1001/archotol.1987.01860030090016

Cited by 26 publications

(6 citation statements)

References 21 publications

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“…Delivered by this method, into the open proximal end of 5-mm x 30-cm and 8mm X 40-cm bronchoscope s tripled and quadrupled the tidal volume, respectively, compared with the injector alone. This is due to entrainment of room air ahead of the jetted gas 66 (Fig. 4).…”

Section: Jet Ventilation Anesthesiamentioning

confidence: 99%

“…Gastric distension is a common complication of supraglottic jetting, due to overflow of gas into the esophagus. 65 Maintaining a low insufflation pressure, i.e., 20 psi vs. 50 psi, was advised by Koufman, et al 66 Subglottic jet ventilation. Subglottic jet ventilation was first performed with 3.5-mm OD plastic chest tubes or by inserting the metal supraglottic tube through the glottis below the level of the vocal cords.0 7 -10 The end of a plastic jet tube tends to whip around in the trachea.…”

Section: Supraglottic Jet Ventilation the Originalmentioning

confidence: 99%

“…This can be caused by misplaceme nt of the supraglottic tube, too high riding laryngoscop e, or simply too much ventilation pressure during supraglottic -jetting. 66 Vocal cord movement. Supraglottic and, to a lesser extent, subglottic jetting may cause movement of the vocal cords to force the surgeon to laser between breaths when the vocal cords are quiet.…”

Section: Complicat Ions Of Ventilatio Nmentioning

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: Jet Ventilation Anesthesiamentioning

confidence: 99%

Section: Supraglottic Jet Ventilation the Originalmentioning

confidence: 99%

Section: Complicat Ions Of Ventilatio Nmentioning

confidence: 99%

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Anesthesia for Microlaryngeal Surgery: The Case for Subglottic Jet Ventilation

Hunsaker

1994

The Laryngoscope

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“…1). 1 Adequate exposure is obtained using an adult‐sized Jako laryngoscope (catalogue No. 52‐2200, Pilling Co., Fort Washington, PA).…”

Section: Methodsmentioning

confidence: 99%

Endoscopic Arytenoid Repositioning for Unilateral Arytenoid Fixation

Amin

Koufman

2001

The Laryngoscope

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“…Advantages of jet ventilation are similar to those ofspontaneous respiration. Negative aspects, however, include the need for constant alignment ofthe laryngoscope, larynx, and trachea; the risk of barotrauma (pneumothorax or pneumomediastinum) or gastric distention and aspiration; and the distal seeding of resected materials (17). As with spontaneous respiration, the trachea and vocal cords are not protected from stray beams (3).…”

Section: Airway Managementmentioning

confidence: 99%