SUPERIMPOSED HIGH-FREQUENCY JET VENTILATION VIA THE JET LARYNGOSCOPE FOR TRACHEOTOMY DUE TO A 5-CM MASSIVE STENOSIS OF THE LARYNX

In a 35-year old male patient with laryngeal carcinoma an acute respir atory insufficiency with early hyperaemia developed due to massive lar yngeal stenosis. An endotracheal intubation was not possible since the available lumen was too small. Tracheotomy using local anaesthesia wa s not possible since spontaneous respiration with a Venturi mask apply ing 100% oxygen was not sufficient and the patient was becoming restle ss and agitated due to the hypoxaemia. Transcutaneous jet ventilation was considered to be too risky since the needle would have to pass hig hly vascularised tumour tissue and the detection of such a small rest lumen would have been quite difficult. Ventilating the patient using a percutaneous catheter would have been very risky as well since, due t o the massive stenosis, a sufficient expiration would not be likely an d therefore was considered to carry a high risk of barotrauma. The pat ient was ventilated under general anaesthesia via a specially designed endoscopy tube with integrated jet nozzles applying superimposed high frequency jet ventilation above the stenosis. Since it was possible t o achieve sufficient ventilation during the inspection of the larynx t he jet laryngoscope was left in place and the supporting apparatus was covered with sterile drapes. The tracheotomy was performed using the superimposed high frequency jet ventilation. Throughout the procedure oxygenation and ventilation were adequate. The laryngectomy performed several days later revealed a cauliflower type protrusion into the tra cheal lumen and a 5 cm long stenosis of the larynx with a lumen of 3 m m.