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GENERAL ARTICLES

Supraglottic Combined Frequency Jet Ventilation Versus Subglottic Monofrequent Jet Ventilation in Patients Undergoing Microlaryngeal Surgery

Department of Anesthesiology and General Intensive Care, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Andreas Bacher, MD, Department of Anesthesiology and General Intensive Care, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Address e-mail to andreas.bacher{at}univie.ac.at

We compared the efficacy of gas exchange during supraglottic combined-frequency jet ventilation via a jet ventilation laryngoscope and during monofrequent jet ventilation via the Mon-Jet catheter (Xomed, Jacksonville, FL). Twenty-three anesthetized (propofol, fentanyl, vecuronium) patients undergoing microlaryngeal surgery were prospectively studied and randomly assigned to one of two groups. The patients’ lungs were ventilated with combined-frequency jet ventilation (10 min, 15 and 600 breaths/min, inspiration/expiration time ratio = 1, driving pressure 750-1500 mm Hg), monofrequent (low-frequency group: 15 breaths/min; high-frequency group: 600 breaths/min) jet ventilation (20 min), and again combined-frequency jet ventilation (15 min). PaO₂, PaCO₂, and the inspiratory oxygen fraction (FIO₂) were measured. Wilcoxon’s signed rank test was applied. During monofrequent jet ventilation, PaCO₂ increased and the PaO₂/FIO₂ decreased significantly (P < 0.05) as compared with combined-frequency jet ventila- tion (low-frequency group: PaCO₂ from 39.4 ± 3.3 to 50.8 ± 8.0 mm Hg, PaO₂/FIO₂ from 306 ± 100 to 225 ± 94 mm Hg; high-frequency group: PaCO₂ from 36.7 ± 7.2 to 60.3 ± 6.1 mm Hg, PaO₂/FIO₂ from 429 ± 87 to 190 ± 51 mm Hg; mean ± SD). After switching back to combined-frequency jet ventilation, PaCO₂ decreased and PaO₂/FIO₂ increased to baseline levels. We conclude that gas exchange during microlaryngeal surgery can be more easily maintained with supraglottic combined-frequency jet ventilation than with subglottic monofrequent jet ventilation via the Mon-Jet catheter.

Implications: This study demonstrates that the combination of high- and low-frequency supraglottic jet ventilation via a jet ventilation laryngoscope provides a better pulmonary gas exchange and allows more accurate airway pressure monitoring during microlaryngeal surgery than subglottic monofrequent jet ventilation via an endotracheal catheter.

This article has been cited by other articles:

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999