B. Depierraz et al., PERCUTANEOUS TRANSTRACHEAL JET VENTILATION FOR PEDIATRIC ENDOSCOPIC LASER TREATMENT OF LARYNGEAL AND SUBGLOTTIC LESIONS, Canadian journal of anaesthesia, 41(12), 1994, pp. 1200-1207
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.