SUPERIMPOSED JET VENTILATION VIA A SPECIA L JET LARYNGOSCOPE FOR ENDOLUMINAL STENT INSERTION IN THE TRACHEOBRONCHIAL TREE

Background. Stenotic processes of the tracheobronchial system may lead to dyspnoea that can become lift-threatening. To restore sufficient f unction of the blocked airway, a silicone stent can be inserted. The a naesthesia techniques used for this intervention so far have been comp licated. The object of this study was to determine whether the superim posed high-frequency jet ventilation (SHFJV) via the jet laryngoscope originally designed for microlaryngeal surgery can be utilised for end oluminal stent insertion. Methods. In 12 patients with acute respirato ry insufficiency (ASA 3-5) due to stenosis of the tracheobronchial sys tem, an endoluminal silicone stent was inserted through the jet laryng oscope while the patient was ventilated using SHFJV. Results. A signif icant rise in paO(2) readings prior to the jet ventilation and subsequ ent measurements was observed. The CO2 elimination was good (average p aCO(2) 31.5+/-7.5-53.1+/-14 mmHg). Variably high paCO(2) readings duri ng stent insertion were related to the respective surgical phases. At the end of the surgical manipulation, all patients had sufficient spon taneous ventilation. Conclusions. First clinical applications of the j et laryngoscope combined with superimposed jet ventilation for stent i nsertion demonstrated satisfactory results. Not only were the patients ventilated throughout the procedure, but CO2 elimination was also sat isfactory. Superimposed jet ventilation provides a sufficient tidal vo lume with low ventilation pressures, and therefore oxygenation and CO2 elimination are unproblematic. SHFJV enables the anaesthetist to vent ilate the patient nearly continuously with minimal phases of apnoea. T he only apnoea phases, as with any other method, occur during surgical manipulation while inserting the stent and thus blocking the airway. We believe that the jet laryngoscope with SHFJV presents a distinct ad vantage for both anaesthetist and surgeon when inserting stents in the tracheobronchial system.