APPLICATION OF TUBELESS SUPERIMPOSED HIGH-FREQUENCY JET VENTILATION (SHFJV) FOR MICROLARYNGEAL LASER-SURGERY

In laser surgery of the larynx the surgeon and the anaesthesist have to compete for the limited space available. The surgeon requiring good visibility and an undisturbed operating area whereas the anesthetist has to ensure sufficient ventilation of the patient. Further, complications of anaesthesia and laser must be avoided. These requirements are met by using the jet-tube (jet-laryngoscope) with two integrated nozzles applying simultaneously low- and high-frequency jet-ventilation giving the surgeon total access to the area operated on, and at the same time enables safe ventilation of the patient. Of 334 operations with the tubeless ventilation technique 76 cases were laser surgical interventions. In 6 patients stenoses were enlarged. The average duration of the jet-ventilation was 25 +/- 10 minutes. The maximum duration of a laser surgical intervention was 140 minutes. The age distribution of the patients was 18 months to 82 years. In all patients pulmonary gas exchange was satisfactory. We believe that the advantage of the tubeless jet-ventilation is: optimal visibility and surgical freedom for the surgeon, no time limitation, even in very severe stenoses. Since no volatile anaesthetics or any type of endotracheal tube are applied there is no danger of interaction with the laser when using the SHFJV via the jet-laryngoscope. Application of the tubeless jet-ventilation technique is however limited if patients suffer from severe pulmonary obstruction; likewise highly obese patients and patients in whom massive bleeding occurs are not amenable to tubeless jet-ventilation.