Dr. Ameen, ENT Specialist in Kuala Lumpur

Dear readers,

Today I’ll be sharing insights on ventilation methods during laryngotracheal surgery. During my training at HUKM, I had the privilege of learning from renowned laryngologists (Prof Dato Abdullah Sani, Prof Marina, and Prof Mawaddah). It was at HUKM that I was introduced to jet ventilation, a technique for intermittently delivering oxygen to patients under general anesthesia without the need for an endotracheal tube. This method offers advantages such as increased surgical efficiency and effectiveness compared to using a tube.

It’s worth noting that not all anesthetists are familiar with jet ventilation, as it’s a specialized approach primarily used in upper airway surgery.

In other settings, I also learned about the intermittent apnea technique during my pediatric rotation, which is an alternative when jet ventilation could lead to complications like pneumothorax. Happy reading!

Abstract

Objective
The objective of this study is to assess the impact of two different ventilation techniques, jet ventilation and apneic anesthesia with intermittent ventilation (AAIV), on patient hemodynamics and operative time during endoscopic laryngotracheal stenosis surgery.

Methods
Retrospective chart review of patients who underwent airway dilation for laryngotracheal stenosis by a single surgeon at a single institution from October 1, 2000 through January 2, 2020. Logistic regression, Mann–Whitney U tests and chi square analysis were used to determine statistical significance.

Results
A total of 157 patients, 43 (27.4%) male and 114 (72.6%) female, and 605 total encounters were included for analysis. There were no significant differences in hemodynamic outcomes when comparing the AAIV and jet ventilation groups. Specifically, there was no significant difference in either peak end-tidal CO2 or nadir O2 saturation between the AAIV and jet ventilation groups (p = 0.4016) and (p = 0.1357), respectively. The patients in the AAIV group had a significantly higher median BMI 32.93 (27.40–39.40) compared with 28.80 (24.1–32.65) (p = 0.0001). Although not necessarily clinically significant, patients with higher BMI had lower median O2 nadirs (97.8%) than non-obese patients (99.2%) (p < 0.0001). The median total procedure time was equivalent when comparing the two ventilation techniques.

Conclusion
AAIV is a safe method of ventilation for patients undergoing endoscopic laryngotracheal stenosis surgery with no significant differences in patient hemodynamics or procedure time when compared with jet ventilation. AAIV was the preferred method of ventilation for obese patients undergoing endoscopic laryngotracheal stenosis surgery.