APPLICATION OF TUBELESS SUPERIMPOSED HIGH -FREQUENCY JET VENTILATION (SHFJV) FOR MICROLARYNGEAL LASER-SURGERY

In laser surgery of the larynx the surgeon and the anaesthesist have t o compete for the limited space available. The surgeon requiring good visibility and an undisturbed operating area whereas the anesthetist h as to ensure sufficient ventilation of the patient. Further, complicat ions of anaesthesia and laser must be avoided. These requirements are met by using the jet-tube (jet-laryngoscope) with two integrated nozzl es applying simultaneously low- and high-frequency jet-ventilation giv ing the surgeon total access to the area operated on, and at the same time enables safe ventilation of the patient. Of 334 operations with t he tubeless ventilation technique 76 cases were laser surgical interve ntions. In 6 patients stenoses were enlarged. The average duration of the jet-ventilation was 25 +/- 10 minutes. The maximum duration of a l aser surgical intervention was 140 minutes. The age distribution of th e patients was 18 months to 82 years. In all patients pulmonary gas ex change was satisfactory. We believe that the advantage of the tubeless jet-ventilation is: optimal visibility and surgical freedom for the s urgeon, no time limitation, even in very severe stenoses. Since no vol atile anaesthetics or any type of endotracheal tube are applied there is no danger of interaction with the laser when using the SHFJV via th e jet-laryngoscope. Application of the tubeless jet-ventilation techni que is however limited if patients suffer from severe pulmonary obstru ction; likewise highly obese patients and patients in whom massive ble eding occurs are not amenable to tubeless jet-ventilation.