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GENERAL ARTICLES

Respiratory Efficacy of Subglottic Low-Frequency, Subglottic Combined-Frequency, and Supraglottic Combined-Frequency Jet Ventilation During Microlaryngeal Surgery

Department of Anesthesiology and General Intensive Care, University of 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 tested the respiratory efficacy of different jet ventilation techniques (subglottic low-frequency versus subglottic combined-frequency and subglottic combined-frequency versus supraglottic combined frequency) in patients undergoing microlaryngeal surgery. The PaCO₂ and the quotient of arterial oxygen tension (PaO₂) over FIO₂ were measured. After anesthetic induction (propofol, remifentanil, vecuronium), an endotracheal Mon-Jet catheter (Xomed, Jacksonville, FL) for subglottic jet ventilation and a laryngoscope for supraglottic jet ventilation (Carl Reiner G.m.b.H., Vienna, Austria) were inserted. In Group 1 (n = 18), subglottic low-frequency (15 breaths/min), combined-frequency (600 and 15 breaths/min), and low-frequency jet ventilation was subsequently performed (15 min each). In Group 2 (n = 19), the sequence was supraglottic, subglottic, and supraglottic combined-frequency jet ventilation. The driving pressures were initially adjusted to achieve normocapnia and were not changed during the entire study period. The FIO₂ was measured endotracheally. The Wilcoxon’s signed rank test was applied. In Group 1, PaCO₂ and PaO₂/FIO₂ improved significantly after switching from subglottic low-frequency to subglottic combined-frequency jet ventilation (PaCO₂, from 46.6 ± 8.3 to 42.1 ± 8.1 mm Hg; PaO₂/FIO₂, from 311 ± 144 to 361 ± 141 mm Hg; P <0.05). In Group 2, PaCO₂ increased and PaO₂/FIO₂ decreased significantly after switching from supraglottic to subglottic combined-frequency jet ventilation (PaCO₂, from 39.4 ± 7.1 to 45.9 ± 7.5 mm Hg; PaO₂/FIO₂, from 415 ± 114 to 351 ± 129 mmHg; P <0.05). We conclude that subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency ventilation, but more effective than subglottic low-frequency jet ventilation.

Implications: The combination of high and low respiratory frequencies (600 and 15 breaths/min) improves pulmonary gas exchange during subglottic jet ventilation via an endotracheal catheter. However, subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency jet ventilation via a jet ventilation laryngoscope.

This article has been cited by other articles:

				A. Rezaie-Majd, W. Bigenzahn, D.-M. Denk, M. Burian, J. Kornfehl, M. Ch. Grasl, G. Ihra, and A. Aloy Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients Br. J. Anaesth., May 1, 2006; 96(5): 650 - 659. [Abstract] [Full Text] [PDF]

				G. A. Baer What to Prefer During Jet Ventilation for Endolaryngeal Procedures, Risk of Barotrauma or of Aspiration of Contaminating Material? Anesth. Analg., December 1, 2001; 93(6): 1625 - 1625. [Full Text] [PDF]

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