Anaesthesia for microlaryngeal and laser laryngeal surgery: impact of subglottic jet ventilation

Abstract

OBJECTIVE: Over the past 20 years, jet ventilation techniques have been developed to enable safe and controlled microlaryngoscopy and the accurate treatment of laryngeal pathology. This study examined how advances in jet ventilation tube design have facilitated safe endolaryngeal surgery. STUDY DESIGN: The study documented the development and use of the Jockjet subglottic jet ventilation tube system at the Prince of Wales Hospital, Sydney. The new system consisted of two components: a Teflon tube with an outer diameter of 4 mm at the larynx, and a companion ventilator. The facility for end-tidal carbon dioxide and distal airways pressure monitoring was incorporated via dedicated channels. The Venturi jet was produced via a covered tip to prevent trauma to the tracheal mucosa. SETTING: The Prince of Wales and Sydney Children's Hospitals, incorporated with The University of New South Wales. PATIENTS: From June 2002 to March 2008 inclusive, 1000 consecutive patients underwent microlaryngeal surgery at this institution. Subglottic jet ventilation, via the Jockjet tube, was employed for 332 patients. MAIN OUTCOME MEASURES: Anaesthetic safety and intra-operative surgical access. RESULTS: In all the 332 patients observed, surgical access was optimised and no adverse anaesthetic outcomes were encountered. CONCLUSION: Subglottic jet ventilation facilitates safe airway management during microlaryngeal and laser laryngeal surgery.