Supralaryngeal tubeless combined high-frequency jet ventilation for laser surgery of the larynx and trachea

We have developed a new technique of combined high-frequency jet ventilatio n (HFJV), characterized by simultaneous application of a low-frequency (LF) and a high-frequency (HF) jet stream. Tubeless supralaryngeal jet ventilat ion was delivered via a modified Kleinsasser laryngoscope. We studied 44 ad ults undergoing 45 elective surgical procedures of the larynx and trachea u sing a carbon dioxide laser during HFJV. Applied inspiratory oxygen ratios ranged from 0.4 to 1.0. Mean driving pressures of the HF and LF jet streams were 1.5 bar and 1.8 bar in adults, respectively. Mean duration of HFJV wa s 41 (range 120-180) min. HFJV resulted in mean Pa-O2 and Pa-CO2 values of 16.6 (range 9.8-26.9) kPa and 5.7 (3.0-7.6) kPa, respectively. Tubeless sup ralarymgeal HFJV was safe and effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses, providing optimal visibility of anatomical structures, offering maximum space for surgical manipulation, a nd avoiding the use of combustible material inside the larynx or trachea.