A. Aloy et al., SUPERIMPOSED JET VENTILATION VIA A SPECIA L JET LARYNGOSCOPE FOR ENDOLUMINAL STENT INSERTION IN THE TRACHEOBRONCHIAL TREE, Anasthesist, 43(4), 1994, pp. 262-269
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.