The mode of ventilation depends on the type of surgery being undertaken . High-frequency jet ventilation gives an optimal surgical view but. approach to the airway and jet ventilation (JV) is a mutually convenient Ossoff RH: Laser safety in otolaryngology–head and neck surgery. ObjectiveTo describe our experience with superimposed high-frequency jet ventilation (SHFJV), JAMA Otolaryngology–Head & Neck Surgery .. This was partly achieved when various forms of jet ventilation were introduced for surgical .

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The second group comprises young children or those with learning difficulties who inhale or ingest foreign objects.

In all patients, electrocardiography, arterial oxygen saturation SaO 2 using a pulse oximeter, and arterial blood pressure using an arterial catheter were monitored simultaneously each datum by an automated device Merlin, model ; Hewlett-Packard Co, Waltham, Mass.

Distinctive connectors prevent incorrect line connections to the jet respirator.

Following surgery to the airway, there is the risk of laryngeal spasm, aspiration, or airway obstruction due to oedema or haematoma formation. Technical diagram of the jet laryngoscope, with arrows indicating the flow of the jet stream.

Copyright American Medical Association. However, there is a risk of barotrauma with use of a high-pressure gas system, especially if the jet is below the larynx. This article discusses anaesthesia for some common airway procedures and paediatric airway problems. The first group comprises elderly patients with coexisting respiratory and cardiovascular morbidity resulting from long-term smoking and high alcohol intake.

If the jet laryngoscope is inserted correctly, the carina can be seen. Anesthesia for airway surgery. This is a common technique using a long, narrow, cuffed tracheal tube e. Create a personal account to register for email alerts with links to free full-text articles.

A larymgology step in achieving adequate ventilation without limiting visibility is the superimposed high-frequency jet ventilation SHFJVwhich was developed in by Aloy et al. General anaesthesia employing an MLT. All staff must be familiar with laser surgery and local safety policies.

Sign in to download free article PDFs Sign in to access laryngo,ogy subscriptions Sign in to your personal account. Often, they are not fasted.


The gas insufflation is distal from the stenosis, and therefore, the technique carries a high risk of barotrauma. Intravenous anesthesia was used in all patients because SHFJV using the jet laryngoscope is an open system. In patients in whom the glottis cannot be visualized through the jet laryngoscope, transtracheal high-frequency ventilation is the technique of choice.

Arch Otolaryngol Head Neck Surg.

Anaesthesia for airway surgery | BJA Education | Oxford Academic

Sign in to customize your interests Sign in to your personal account. The effects on laryngeal function and airway patency must also be investigated. They often require invasive intraoperative monitoring and short-acting opioids such as remifentanil.

Movements of the vocal cords due to the low-frequency jet stream are diminished to a great extent larynoglogy the high-frequency jet stream, which prevents a complete closure of the vocal cords, and only a slight movement of the peripheral parts of the vocal cords is observed. These patients often do not tolerate a supine position and may need to remain sitting through the induction of anaesthesia or during the performance of tracheostomy.

This article was originally published in. However, there is often reduced access to the surgical field and the tracheal tube obscures the posterior one-third of the glottis.

Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more. Laryngeal and tracheal stenosis. This is a correction to: The inspiratory pressures measured ventilztion the tip of the jet laryngoscope were 5.

This has the disadvantages of poor airway protection and poor control of depth of anaesthesia but the advantage of an unobstructed surgical view. In patients with laryngeal stenosis Cotton II and III4 respiration might be impaired to such a degree that even surgical procedures using local anesthesia might not be possible.

Even in patients at high risk because of pulmonary or cardiac disease, this technique can be applied safely.

The SHFJV can be used for tracheobronchial stent insertion, and laser can be used without any additional protective measures. High-frequency jet ventilation gives an optimal surgical view but requires specialized equipment, expertise, and a TIVA technique. Passing through the jet nozzles, the gas stream undergoes changes.


High-frequency jet ventilation–a review of its role in laryngology.

Airway trauma may be penetrating or blunt. These ventlation provide the optimal surgical view and reduce the degree of stimulation but there is no physical protection of the airway. A misplacement of the jet nozzles is not possible because the jet nozzles are integrated into the jet laryngoscope.

In patients with stenosis, the ventilation is vehtilation from above the stenosis, reducing the risk of barotrauma. This pressure drop and the placement of the jet nozzles in the proximal part of the endoscope ensure that no high pressures occur in the distal part of the endoscopy tube. There is a potential risk of cross-infection to theatre staff if papillomata net resected using a laser device due to aerosolization of virus-laden particles. Topical laryngeal anaesthesia and administration of a short-acting opioid will diminish the stress response to surgery during instrumentation.

The population presenting for airway surgery mainly falls into two categories. For Permissions, please email: Postoperatively, all patients had sufficient spontaneous respiration. In the absence of critical airway stenosis, the tracheostomy may be performed after induction of anaesthesia. The rigid bronchoscope is used for diagnosis of lesions in the respiratory tract down to the main bronchus and therapeutic interventions such as dilation of tracheal stenosis, airway tumour resection, and foreign body removal.

Sign in to make a comment Sign in to your personal account. Evaluation of the location, size, extent, and mobility of any lesion is required. There should be good teamwork in theatre. Psychosocial factors include fear of choking, death, and inability to communicate following tracheostomy.

Subglottic jet techniques applied through the larynx 67 or percutaneously through the trachea 8 with thin catheters provide safe ventilation during endolaryngeal surgery, if no major narrowing of the glottic space exists.