High-frequency jet ventilation for endolaryngotracheal surgery--chart review and procedure analysis from the surgeon's and the anaesthesiologist's point of view.

ABSTRACT

OBJECTIVE: High-frequency jet ventilation (HFJV) arose as a ventilation alternative in laryngotracheal surgery as it offers the surgeon a better overview and more space for microsurgical manipulations. On the contrary, anaesthesiologic monitoring is limited and (relative) contraindications exist. The aim of this study was to evaluate the procedure. Contraindications and limitations are discussed from the surgeon's and the anaesthesiologist's point of view, and relevant aspects of oncologic surgery are identified. DESIGN: Retrospective chart review and analysis of clinical experiences. SETTING: University Teaching hospital. PATIENTS AND MAIN OUTCOME MEASURES: Eighty adult patients (97 cases) treated at our institution between June 2012 and September 2013 were included. HFJV was performed using thin, subglottically placed catheters. The analysis focuses on complications and practical steps. RESULTS: Indications were benign (63%) and malignant pathologies (37%). The CO2 laser was used in 34 cases (35%). The mean operating time averaged 53 min (3-404 min) and the mean duration of anaesthesia was 81 min (16-438 min). Two thirds of the operated patients had a body mass index higher than 25 kg/m(2) . Eighty-four per cent were classified as ASA I and II according to the American Society of Anesthesiologists. All pathologies could well be exposed by the surgeon. Two reversible desaturations to 70% were documented. In another case, emergency re-intubation was necessary as the saturation dropped below 50%. In 8 (8%) cases, elective re-intubation to conventional tubes was performed during the course of the operation as HFJV did not establish optimal oxygenation conditions. No severe intra-operative bleeding was observed. CONCLUSIONS: High-frequency jet ventilation represents a safe ventilation approach for laryngotracheal surgery in experienced hands. Due to the better overview, it offers a better orientation on anatomical structures and on the pathology. Special attention has to be laid on obesity, reflux and cardiopulmonary diseases. However, individual decisions can be made under consideration of all co-morbidities. A close pre- and intra-operative interdisciplinary work up is required.