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Anesth Analg 2001;93:1625
© 2001 International Anesthesia Research Society

LETTERS TO THE EDITOR

What to Prefer During Jet Ventilation for Endolaryngeal Procedures, Risk of Barotrauma or of Aspiration of Contaminating Material?

Gerhard A. Baer, MD PhD

Department of Anesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland

To the Editor:

Combined frequency jet ventilation provides better oxygenation and CO2 elimination than low frequency jet ventilation (1,2); however, the conclusion of the abstract that subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency jet ventilation (1) is not entirely correct. The (airway) pressure a jet pump achieves is not only determined by driving gas pressure but also by the relation of the diameters of the jet and the tube the jet blows into, the diffuser (laryngoscope, trachea) (3). The two compared jet pumps (ventilating laryngoscope versus subglottic jet) (1) cannot produce the same airway pressure at the same driving pressure. Different airway pressures result in different gas exchange (4). At the same airway pressure, there is no difference in gas exchange. The real difference is the special risk each method inheres; this should interest the clinician and his patient. Barotrauma is the risk of subglottic jet ventilation, but effective airway pressure monitoring is possible and aspiration virtually impossible (5). Aspiration of blood and contagious material is the risk of supraglottic jet ventilation (6). No latter complications have been published but large controlled trials would be needed to rule out the possibility of the risk (7).

Footnotes

Dr. Bacher did not wish to respond.

References

  1. Bacher A, Lang T, Weber J, Aloy A. Respiratory efficacy of subglottic low-frequency, subglottic combined-frequency, and supraglottic combined-frequency jet ventilation during microlaryngeal surgery. Anesth Analg 2000; 91: 1506–12.[Abstract/Free Full Text]
  2. Bacher A, Pichler K, Aloy A. Supraglottic combined frequency jet ventilation versus subglottic monofrequent jet ventilation in patients undergoing microlaryngeal surgery. Anesth Analg 2000; 90: 460–5.[Abstract/Free Full Text]
  3. Perry RH. Ejector performance. In: Perry RH, Chilton CH, eds. Chemical engineer’s handbook. New York: McGraw-Hill, 1973: 29–32.
  4. Takahashi H, Takezawa J, Nishijima MK, et al. Effects of driving pressure and respiratory rate on airway pressure and PaCO2 in rabbits during high-frequency jet ventilation. Critical Care Med 1985; 13: 728–32.[Medline]
  5. Baer GA. No need for claims: facts rule performance of jet ventilation. Anesth Analg 2000; 91: 1040–1.[Free Full Text]
  6. Oulton JL, Donald DM. A ventilating laryngoscope. Anesthesiology 1971; 35: 540–2.[ISI][Medline]
  7. Baer G. Complications and technical aspects of jet ventilation for endolaryngeal procedures. Acta Anaesthesiol Scand 2000; 44: 1273–4.[Medline]



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Lippincott, Williams & Wilkins 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 HighWire Press