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Normofrequent Intratracheal Jet Ventilation - Simple and Useful for Endolaryngeal and Airway Stenosis Surgery.

Normofrequent Intratracheal Jet Ventilation - Simple and Useful for Endolaryngeal and Airway Stenosis Surgery. J.Samarütel, M.Kull Dept of Anaesthesia and Intensive Care and ENT, University of Tartu, Estonia.

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Normofrequent Intratracheal Jet Ventilation - Simple and Useful for Endolaryngeal and Airway Stenosis Surgery.

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  1. Normofrequent Intratracheal Jet Ventilation - Simple and Useful for Endolaryngeal andAirway Stenosis Surgery. J.Samarütel, M.Kull Dept of Anaesthesia and Intensive Care and ENT, University of Tartu, Estonia.

  2. Jet ventilation (JV), the term used for pulsed application of gas (mostly O2) jet into the airway without airtight connection of the patient to the ventilator, is the core element of modern techniques of management of this kind of ENT surgery under general anaesthesia (GA). JV could be subdivided: • High frequency (HF) techniques - HF Positive Pressure Ventilation, HFJV, HFOscillation- mostly applicable only with sophisticated, expensive equipment • Normofrequent JV (rarely used, known mostly as part of Difficult Airwayalgorithms)

  3. HFV and JV – history Henderson Y. et al – 1915 Emerson JH – 1959 Sanders RD – 1967 Öberg PÅ & Sjöstrand U – 1967 HFPPV, HFJV, HFO, HFFI, HFPV

  4. In ENT surgery JV is further subdivided: • Supraglottic, endopharyngeal - jet pipe situated higher than vocal cords, usually connected to surgeon's laryngoscope. • Infraglottic, intratracheal - jet pipe is introduced translaryngeally, transtracheally or through tracheostomy opening. Oxygen jet is blown into the trachea distally to vocal cords or stenotic area.

  5. Up to December 2005 we have performed more than 1900 endoscopic operations with intratracheal (infraglottic) JV on patients of both sexes, in age 4 months to 86 yrs, BW 5,2-170 kg. In first 200 cases original electronic HFJV equipment (so called Double Frequency Jet Ventilation, DFJV) and hand-operated valve with FiO2 1,0 were used alternatively. Both provided full oxygenation and acceptable CO2 removal for up to 140 minutes duration of anaesthesia. In last > 1700 procedures hand-operated valve was used exclusively. Ventilation through small metal pipe provided surgeon with best possible operating conditions for correction of endolaryngeal pathology, removal of obstructing masses, dilatation and stenting of stenoses, use of original NdYAG laser in contact regimen.

  6. Jet pipe or catheter could be introduced through tracheostomy. The x-ray shows end of tracheal dilatation and stenting procedure with ventilation managed through metal pipe, introduced through tracheostomy and to be removed after awakening of the patient. Most of our cases have been managed as outpatients. Anaesthesia includes: • Paracetamol preload (1,5-2,0 g p.o. in adults) • TIVA:Atropine, Fentanyl, Lidocaine, Methohexital (Etomidate), Propofol • Succinylcholine (with antidepolarizer pre-treatment) • Special cases - awake intubation • Introduction of j et catheter or pipe through tracheostomy • Monitoring includes NIBP, EKG and SpO2

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