Anaesthetic considerations in laryngology
Declan Costello, Guri Sandhu in Practical Laryngology, 2015
Jet ventilation techniques are suitable for ventilation during surgery of most adult vocal cord and tracheal lesions including benign laryngeal lesions, airway stenosis, placement of airway stents, rigid bronchoscopy, tracheal resection and dysplastic airway lesions. The main limitation for their use is the experience of the anaesthetist and the absence of suitable equipment. Jet ventilation involves the intermittent administration of high-pressure sourced oxygen, air or oxygen/air mixtures, which entrain room air and lower the delivered pressures. The risk of life-threatening barotrauma is the most serious complication and occurs when entrainment of room air is absent. This results in the delivery of continuous gas with no ability of the delivered gas to escape, leading to pneumomediastinum, pneumothorax and surgical emphysema. Since 1967, when Sanders first described the technique, modifications to the frequency of ventilation (low-frequency, high-frequency or superimposed-frequency jet ventilation) and the site at which the jet emerges in the airway (supraglottic, subglottic or transtracheal) have been made.
Front of Neck Access
Kajal Jain, Nidhi Bhatia in Acute Trauma Care in Developing Countries, 2023
Needle techniquePalpate the neck structures in the midline and identify the thyroid cartilage, cricoid cartilage and cricothyroid membrane in between the two cartilages.Using a small calibre angiocath and saline-containing syringe, the cricothyroid membrane is punctured at a 45 degree angle in the caudad direction, the airway is confirmed (using aspiration) and the angiocath is inserted percutaneously.High-pressure oxygen is insufflated into the trachea. The expiration is passive. This technique is known as jet ventilation.
Anaesthesia for Paediatric Otorhinolaryngology Procedures
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
The larynx is also sprayed with lidocaine to decrease the response to instrumentation, although care must be taken to ensure the patient is anaesthetized deeply enough to avoid temporary laryngospasm when this is done. Oxygenation can be obtained by means of a nasal airway attached to an Ayres ‘T’ piece anaesthetic circuit. If the patient is to be ventilated, they are better intubated. Jet ventilation, frequently used in adults, carries significant risk of barotrauma in small children although some centres use it successfully.19 This is not our practice, as we believe the disadvantages far outweigh any benefits. Finally, a dose of dexamethasone is given to patients to try to reduce any oedema that may affect the airway post-operatively. The evidence for this is scanty but most experienced airway anaesthetists feel that this is of value.20
Stents for small airways: current practice
Published in Expert Review of Respiratory Medicine, 2020
Paul Zarogoulidis, Konstantinos Sapalidis, Christoforos Kosmidis, Kosmas Tsakiridis, Haidong Huang, Chong Bai, Wolfgang Hohenforst-Schmidt, Stavros Tryfon, Anastasios Vagionas, Konstantinos Drevelegas, Eleni-Isidora Perdikouri, Lutz Freitag
Interventional bronchoscopy with balloon dilation can reestablish airway patency but restenosis can occur and it depends on the plasticity of the inflammatory tissue. This technique is usually used in benign stenosis where we have scar tissue. Regarding malignancies, restenosis depends on the effectiveness of the systematic and local treatment before stent placement. Depending on the cancer type (lung cancer or metastatic cancer), patients receive systematic therapy and in some cases local therapy with radiotherapy and ablation with microwaves or argon plasma coagulation, YAG-laser, and/or cryotherapy probe. Usually we treat the patient under general anesthesia, we insert a rigid bronchoscope with a diameter depending from the trachea of the patient. Sometimes we can just intubate the patient with a large diameter tube No. 9 and insert flexible instruments from there (semi-rigid technique). There is also the case where we can directly insert a stent with a laryngeal scope and special releasing equipment [3,4]. Jet-Ventilation model is usually used where available; with this mode of ventilation we keep high oxygen levels and low CO2 concentration during the procedure [5]. Extracorporeal oxygenation could also be used in some severe cases [6]. Fluoroscopy and or cone beam CT can also be used in many patients for optimal stent insertion [3,7].
Indications and complications of rigid bronchoscopy
Published in Expert Review of Respiratory Medicine, 2018
Ventilation strategies for rigid bronchoscopy have evolved considerably over the past few decades. The various methods of ventilation include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation (closed system), manual jet ventilation and high-frequency jet ventilation [14]. The most common technique in the 1990s was the use of spontaneous assisted ventilation with intravenous anesthesia. However, the high-risk patient population suffering from CAO suffered frequent episodes of hypoxemia with this strategy. This has led to a paradigm shift away from this mode over the past two decades [15]. Even in pediatric populations, the use of spontaneous ventilation has been shown to increase the risk of hypoxemia and other complications during rigid bronchoscopy [8].
Novel tubeless supraglottic ventilation in a difficult paediatric airway
Published in Egyptian Journal of Anaesthesia, 2018
Ng Ruth, Budiman Maryam, Azman Mawaddah, Goh Bee-See
Management of the difficult airway in an operative setting requires careful planning to avoid morbidity and mortality. Especially for paediatric patients with expected difficult airway, it is crucial to pay close attention to the details of implementing the chosen approach [1]. In our setting, we routinely conduct fruitful discussion between the anaesthesiologist and the operating airway surgeon on how the airway is to be managed intraoperatively. While jet ventilation provides tubeless ventilation in advantage of the airway surgeon, associated morbidities must be considered, especially in the paediatric patients with severe lung condition. We report a novel method for tubeless supraglottic ventilation in the management of a child with underlying right lobar collapse secondary to severe pneumonia, and upper airway obstruction secondary to tracheal stenosis.
Related Knowledge Centers
- Continuous Positive Airway Pressure
- Respiratory Failure
- Chronic Obstructive Pulmonary Disease
- Mechanical Ventilation
- Respiratory Therapist
- Nomenclature of Mechanical Ventilation
- Intubation
- Airway Pressure Release Ventilation
- Pulmonary Alveolus
- Positive Airway Pressure