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

Arch Otolaryngol Head Neck Surg. 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.

The SHFJV is superior to the single-frequency jet ventilation techniques for use in obese patients and patients with pulmonary diseases. Arterial blood gas values were analyzed.

Developing a ventilation technique that does not obstruct the visibility of the operating field but ensures the adequate ventilation of patients has been the declared goal. The mode of ventilation depends on the type of surgery being undertaken and the access required to the operative site see Table 1.

Passing through the jet nozzles, the gas stream undergoes changes. The 2 jet nozzles are placed apart, one beside the other toward the distal end of the jet laryngoscope. A misplacement of the jet nozzles is not possible because the jet nozzles are integrated into the jet laryngoscope. These patients often have malignant lesions and may show side-effects of its treatment e.

This is usually delivered using a micro-laryngoscopy tube MLT. It is often life-threatening and should be managed by senior anaesthetic and surgical personnel who should form a joint management plan preoperatively.

Ensure that the tracheostomy tube is securely fixed as re-insertion is often difficult. A further step in achieving adequate ventilation without limiting visibility is the superimposed high-frequency jet ventilation SHFJVwhich was developed in by Aloy et al.

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

In the presence of acute-onset stridor, investigations should be kept to a minimum. The Albert-Sanders adaptor for ventilating anaesthetized patients for micro-laryngeal surgery.


A crico-thyroid cannula or orotracheal catheter may be left in place to facilitate emergency oxygenation during the recovery period. The ventilaton FIO 2 values are presented in Figure 2. Aloy et al 11 demonstrated in 23 patients with laryngeal stenosis Cotton II and III that, with proper adjustment of the respirator and using long inspiration times and a high working pressure, it is possible to overcome the high inspiratory resistance and to provide adequate ventilation.

Sign in to access your subscriptions Sign in to your personal account. A preoperative fibreoptic endoscopic examination which may be performed using topical, nasal anaesthesia is an extremely useful investigation, allowing formation of a joint management layrngology.

There is a potential risk of cross-infection to theatre staff if papillomata are resected using a laser device due to aerosolization of virus-laden particles. Of the patients, were female, were male, and 40 were children ranging from neonate to 14 years of age.

Superimposed High-Frequency Jet Ventilation for Laryngeal and Tracheal Surgery

The SaO 2determined by pulse oximetry, ventilatipn between If no movement at all is required, the larynngology jet stream laryyngology be shut off for a short time. As a result of the design of the angle of insertion of the cannulas, the entering gas streams do not hit the opposite wall of the jet laryngoscope but are directed toward the center of the distal end of the jet laryngoscope.

Ann Otol Rhinol Laryngol. Sign In or Create an Account. 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.

Copyright American Medical Association. Both ventilators work with an oxygen-air mixture, and both have integrated manometers for displaying the inspiratory pressure.

Because the gas pressures are already low in the plane of the operating field and further decrease toward the trachea, no adverse hemodynamic effects are observed when using the SHFJV.

Anaesthesia for airway surgery | BJA Education | Oxford Academic

When used supra-glottically there is a risk of gastric insufflation. Evaluation of the location, size, extent, and mobility of any lesion is required.

Previous anaesthetic and surgical findings are useful, though tumours may grow rapidly and radiotherapy can change tumour size, appearance, and mobility. The ventilation pressure was measured continuously at the tip of the jet laryngoscope, and arterial blood gas analysis was performed every 5 minutes.


This article discusses anaesthesia for some common airway procedures and paediatric airway problems. At the end of the surgical procedure and after the patient regained protective reflexes, the jet laryngoscope was removed. Emergency airway interventions should only be undertaken with laryngoloogy experienced ENT surgeon present.

Intraoperative problems include cuff perforation, loss of airway control due to difficult insertion of the tracheostomy tube ensure pre-oxygenation prior to tube insertionand airway fire cutting vsntilation should be avoided. Direct laryngoscopy is performed to investigate and treat potential pathology in the upper airway and may or may not involve the use of an operating microscope.

The FIO 2 usually ranges between 0. A patient can be given ventilation up to when the stent is placed in laryngoloty final position.

Laser surgery was performed in patients. This has the disadvantages of poor airway protection and poor control of depth of anaesthesia but the advantage of an unobstructed surgical view.

It produces an unobstructed view of the operative field. In patients, satisfactory ventilation and oxygenation were achieved, with optimal conditions for the surgeons. Demonstration of the positioned jet laryngoscope during ventilation and the free airways in a patient with squamous cell carcinoma of the right anterior vocal cord.

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. No complications related to the ventilation technique occurred. This is a common technique using a long, narrow, cuffed tracheal tube e.

There is a need for TIVA and paralysis, but the vocal cords may still impair gas egress, risking barotrauma. Oxford University Press is a department of the University of Oxford. Profound muscle relaxation is achieved with intermittent iet combined with atropine to avoid bradycardia or a short-acting non-depolarizing agent e. Privacy Policy Terms of Use.

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