Transtracheal high-frequency jet ventilation in a patient with limited mouth opening for endolaryngeal surgery: A case report

In this article, we report a case describing the airway management and anesthetic technique of a 47-year-old male patient undergoing endolaryngeal surgery with extremely limited mouth opening due to previous maxillofacial trauma. An excisional biopsy was planned after laryngoscopic examination for a possible pathological right vocal cord irregularity. Anterior open laryngofissure approach under transtracheal high-frequency jet ventilation was performed after reviewing all possibilities. Neither direct laryngoscopy nor any endolaryngeal instrument placement was possible in this case. This approach was considered the most preferable choice to provide an unobstructed surgical field and safe gas exchange without requiring additional invasive procedure.

___

  • Evans E, Biro P, Bedforth N. Jet ventilation. Continuing Education in Anaesthesia. 2007;7:2-5.
  • Bourgain JL, Desruennes E, Fischler M, Ravussin P. Transtracheal high frequency jet ventilation for endoscopic airway surgery: a multicentre study. Br J Anaesth 2001;87:870-5.
  • Chandradeva K, Palin C, Ghosh SM, Pinches SC. Percutaneous transtracheal jet ventilation as a guide to tracheal intubation in severe upper airway obstruction from supraglottic oedema. Br J Anaesth 2005;94:683-6.
  • Fagan J, editor. Open Access Atlas Of Otolaryngology, Head & Neck Operative Surgery. Available from: https://vula.uct.ac.za/access/content/ group/ba5fb1bd-be95-48e5-81be-586fbaeba29d/ Parotidectomy-1.pdf
  • Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827-48.
  • Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993;78:597-602.
  • Gulleth Y, Spiro J. Percutaneous transtracheal jet ventilation in head and neck surgery. Arch Otolaryngol Head Neck Surg 2005;131:886-90.
  • Hegde MC, Kamath MP, Bhojwani K, Peter R, Babu PR. Benign lesions of larynx-A clinical study. Indian J Otolaryngol Head Neck Surg 2005;57:35-8.
  • Weymuller EA Jr, Pavlin EG, Paugh D, Cummings CW. Management of difficult airway problems with percutaneous transtracheal ventilation. Ann Otol Rhinol Laryngol 1987;96:34-7.
  • Mchugh R, Kumar M, Sprung J, Bourke D. Transtracheal jet ventilation in management of the difficult airway. Anaesth Intensive Care 2007;35:406-8.