PERCUTANEOUS TRANSTRACHEAL JET VENTILATION FOR PEDIATRIC ENDOSCOPIC LASER TREATMENT OF LARYNGEAL AND SUBGLOTTIC LESIONS

Percutaneous transtracheal high frequency jet ventilation (TTJV) in ad ults is frequently used during anaesthesia for laryngeal microsurgery. It provides excellent surgical operating conditions and safety for th e patient. The technique has not been evaluated in infants and childre n. Accordingly, we studied 16 infants and children (mean age 5.5 +/- 3 .8 yr, range 6 wk-12 yr) who underwent 28 consecutive endoscopic proce dures with laser microsurgery of the glottic or subglottic space under general anaesthesia using a TTJV technique. All patients had a severe obstructive lesion of the larynx and/or upper trachea. The mean durat ion of the procedure was 70 +/- 27 min (range 30-140 min). Indications for TTJV were: subglottic stenosis: 5, haemangioma: 4, laryngeal papi llomatosis: 5, pharyngeal cyst: 1, laryngomalacia: 1. Adequate control of the airway and satisfactory gas exchange were obtained in all care s. Surgery was performed without being impeded by anaesthetic equip me nt. Three complications occurred: one extensive surgical emphysema; on e bilateral pneumothorax; one severe vagus-induced cardiovascular depr ession. Prompt and complete recovery without sequelae followed appropr iate treatment. In 32% of the cases, the children were outpatients and in about half of the procedures (13/28) they left the hospital betwee n the first and the third day We conclude that percutaneous transtrach eal jet ventilation is effective in paediatric endoscopic surgery. Pro cedures that might otherwise require a tracheostomy can be performed s afely with this minimally invasive technique. Adequate indications and appropriate understanding of the technique and its potential problems are required for its correct application and successful use.