THE USE OF AN ENDOTRACHEAL VENTILATION CATHETER FOR JET VENTILATION DURING A DIFFICULT INTUBATION

This case report describes the use of an endotracheal ventilation cath eter (ETVC) to provide prolonged intraoperative jet ventilation, reint ubation and the maintenance of tracheal access following extubation. I t emphasizes that excellent oxygenation and ventilation can be achieve d but such management can be complicated by a pneumothorax even when t he risks are minimized. A 43-yr-old man presented for possible pulmona ry sleeve resection. Placement of a double lumen endotracheal tube (DL T) by direct laryngoscopy was unsuccessful due to the inability to vis ualize the glottis. A 7.5 mm endotracheal tube (ETT) was successfully introduced over a fibreoptic bronchoscope (FOB) An ETVC was passed, pe rmitting manually cycled jet ventilation while general intravenous ana esthesia and muscle relaxation were maintained The ETT then withdrawn over the ETVC and jet ventilation continued for approximately 90 min, while attempts at placing a DLT over a now malfunctioning FOE continue d. These attempts were eventually abandoned and the patient was return ed to the post-anaesthesia care unit (PACU) haemodynamically stable. T he trachea was extubated over the ETVC, which remained in situ. A pneu mothorax was noted on the postoperative chest x-ray. This case illustr ates prolonged intraoperative jet injection via a ''jet stylet'' with satisfactory ventilation and oxygenation but complicated by a pneumoth orax. Also it illustrates a strategy for the management of a ''difficu lt extubation.''