To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery

Md, Mausumi N Syamal; Hanisak, Jill; Macfarlan, Jennifer; Ortega, Briana; Sataloff, Robert T.; Benninger, Michael S.

doi:10.1002/lary.29750

Cited by 5 publications

(11 citation statements)

References 34 publications

(71 reference statements)

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“…7 In their study, median peak CO 2 and median O 2 nadir values were similar in the AAIV, THRIVE/Optiflow, and jet ventilation groups. 7 One would suspect that O 2 nadirs would be lower in the AAIV group as a decrease in oxygen can be the threshold for reintubation; however, we found no difference. At our institution, there is no set time limit or oxygen saturation at which the patient is reintubated, and typically the patient is reintubated prior to desaturating.…”

Section: Discussionmentioning

confidence: 80%

“…In Syamal et al's similar study comparing AAIV and fully apneic surgeries, patients were supplemented with transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE/Optiflow) to prolong apnea times. The authors found that O 2 nadirs were lower in the AAIV group although they found similar oxygen saturation distributions between fully apneic and intubated cases 7 . In their study, median peak CO 2 and median O 2 nadir values were similar in the AAIV, THRIVE/Optiflow, and jet ventilation groups 7 .…”

Section: Discussionmentioning

confidence: 82%

“…The authors found that O 2 nadirs were lower in the AAIV group although they found similar oxygen saturation distributions between fully apneic and intubated cases 7 . In their study, median peak CO 2 and median O 2 nadir values were similar in the AAIV, THRIVE/Optiflow, and jet ventilation groups 7 . One would suspect that O 2 nadirs would be lower in the AAIV group as a decrease in oxygen can be the threshold for reintubation; however, we found no difference.…”

Section: Discussionmentioning

confidence: 91%

See 2 more Smart Citations

Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery

Sax,

Sharma,

Benedict

et al. 2023

The Laryngoscope

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ObjectiveThe objective of this study is to assess the impact of two different ventilation techniques, jet ventilation and apneic anesthesia with intermittent ventilation (AAIV), on patient hemodynamics and operative time during endoscopic laryngotracheal stenosis surgery.MethodsRetrospective chart review of patients who underwent airway dilation for laryngotracheal stenosis by a single surgeon at a single institution from October 1, 2000 through January 2, 2020. Logistic regression, Mann–Whitney U tests and chi square analysis were used to determine statistical significance.ResultsA total of 157 patients, 43 (27.4%) male and 114 (72.6%) female, and 605 total encounters were included for analysis. There were no significant differences in hemodynamic outcomes when comparing the AAIV and jet ventilation groups. Specifically, there was no significant difference in either peak end‐tidal CO2 or nadir O2 saturation between the AAIV and jet ventilation groups (p = 0.4016) and (p = 0.1357), respectively. The patients in the AAIV group had a significantly higher median BMI 32.93 (27.40–39.40) compared with 28.80 (24.1–32.65) (p = 0.0001). Although not necessarily clinically significant, patients with higher BMI had lower median O2 nadirs (97.8%) than non‐obese patients (99.2%) (p < 0.0001). The median total procedure time was equivalent when comparing the two ventilation techniques.ConclusionAAIV is a safe method of ventilation for patients undergoing endoscopic laryngotracheal stenosis surgery with no significant differences in patient hemodynamics or procedure time when compared with jet ventilation. AAIV was the preferred method of ventilation for obese patients undergoing endoscopic laryngotracheal stenosis surgery.Level of Evidence3 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 91%

See 1 more Smart Citation

Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery

Sax,

Sharma,

Benedict

et al. 2023

The Laryngoscope

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“…The correlation of longer operative times and risk bears consideration for any laryngeal surgeon especially when airway surgery is being performed and apneic techniques are utilized. Operatives time considerations are balanced with concern for oxygenation depletion and carbon dioxide accumulation in apneic techniques 23 . However, previous work by the author and others have shown safe apnea times (i.e., those without adverse events or carbon dioxide retention) ranging from 24 to 30 min 20,24 .…”

Section: Discussionmentioning

confidence: 99%

Examining readmissions following outpatient microlaryngeal surgery

Kincaid

Sutter

2023

Laryngoscope Investig Oto

Self Cite

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ObjectiveThe objective of this study was to examine readmissions following microlaryngeal surgery. It was hypothesized that airway surgical procedures would have higher rates of readmission.DesignRetrospective review.MethodsOutpatient microlaryngeal surgeries from May 1, 2018 to November 27, 2022 were reviewed. Readmissions related to the original surgery within a 30‐day postoperative period were examined. Patient demographics, body mass index, American Society of Anesthesiologist class, comorbidities, type of surgery, ventilation techniques, and operative times were examined and compared.ResultsOut of 480 procedures analyzed, 19 (4.0%) resulted in a readmission, 9 (1.9%) of which were for glottic stenosis management. Undergoing an airway procedure was significantly associated with a readmission (p = .002) and increased the odds of readmission by 5.99 (95% confidence interval [CI]: 2.22–16.16, p < .001). Current/former smoking status increased the odds of readmission by 4.50 (95% CI: 1.33–15.19, p = .016). Each additional minute of operating time increased the odds of readmission by 1.03 (95% CI: 1.00–1.05, p = .04).ConclusionReadmissions from microlaryngeal surgery are seldom reported but nonetheless occur. Identifying factors that may place a procedure at risk for readmission can help improve surgical quality of care.Level of Evidence4.

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“…The outcomes of HFNC studies are summarised in Table 5 . The duration of surgery was reported by two studies; 12.4 (4.4) minutes by Yang et al [ 48 ] and 20.8 (7.8) minutes by Gustafsson et al [ 56 ]. The duration of apnea was reported by 12 studies, the median was 21.7 minutes (IQR = 17-24.55, range = 10-30).…”

Section: Reviewmentioning

confidence: 99%

High-flow Nasal Cannula versus Conventional Ventilation in Laryngeal Surgery: A Systematic Review and Meta-analysis

Chan¹,

Yang²,

Khu³

et al. 2023

Cureus

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High-flow nasal cannula (HFNC) is an emerging option for maintaining oxygenation in patients undergoing laryngeal surgery, as an alternative to traditional tracheal ventilation and jet ventilation (JV). However, the data on its safety and efficacy is sparse. This study aims to aggregate the current data and compares the use of HFNC with tracheal intubation and jet ventilation in adult patients undergoing laryngeal surgery. We searched PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), Embase (Excerpta Medica Database), Google Scholar, Cochrane Library, and Web of Science. Both observational studies and prospective comparative studies were included. Risk of bias was appraised with the Cochrane Collaboration Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) or RoB2 tools and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for case series. Data were extracted and tabulated as a systematic review. Summary statistics were performed. Meta-analyses and trial sequential analyses of the comparative studies were performed. Forty-three studies (14 HFNC, 22 JV, and seven comparative studies) with 8064 patients were included. In the meta-analysis of comparative studies, the duration of surgery was significantly reduced in the THRIVE (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange) group, but the number of desaturations, need for rescue intervention, and peak end-tidal CO 2 were significantly increased compared to the conventional ventilation group. The evidence was of moderate certainty and there was no evidence of publication bias. In conclusion, HFNC may be as effective as tracheal intubation in oxygenation during laryngeal surgery in selected adult patients and reduces the duration of surgery but conventional ventilation with tracheal intubation may be safer. The safety of JV was comparable to HFNC.

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To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery

Cited by 5 publications

References 34 publications

Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery

Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery

Examining readmissions following outpatient microlaryngeal surgery

High-flow Nasal Cannula versus Conventional Ventilation in Laryngeal Surgery: A Systematic Review and Meta-analysis

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