1
|
Gallagher L, Todatry S, Oldenburg K, Misono S, Gray R. Endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway. Laryngoscope 2024; 134:2672-2677. [PMID: 38095278 DOI: 10.1002/lary.31229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway (LMA) approach. METHODS The records of all patients who underwent endoscopic surgery for subglottic stenosis (SGS) from November 2019 to January 2023 at an academic medical center were reviewed with attention to demographics, patient comorbidities, airway stenosis characteristics, operative time details, surgical complications, and post-operative course. All patients, >18 years old, with one or more surgeries for SGS using (LMA) for intraoperative airway management were included. Surgeries with suspension microlaryngoscopy were excluded. Patients with glottic stenosis or tracheotomy were excluded. RESULTS Thirty-five patients underwent 52 procedures meeting inclusion criteria. Mean age was 55 years (range 31-78, SD 13.3) and 33 patients (94%) were female. Mean BMI was 30.9 (range 18.4-60.5, SD 8.8). The most common etiology of stenosis was intubation injury in 17 patients (49%), followed by idiopathic in 13 patients (37%). Cotton-Meyer grade 3 (71-99% narrowing) was seen in 25 patients (71%). Mean anesthesia and surgical operative times were 75.9 min (SD 13.5 min) and 39.7 min (SD 11.0 min), respectively. Mean SpO2 nadir was 94.5% (SD 6.3%). No patients required intraoperative change to rigid laryngoscopy, intubation, or tracheotomy. There were no post-operative complications. Mean surgery-free interval was 12.2 months (SD 6.3). CONCLUSION Endoscopic treatment of subglottic stenosis with flexible bronchoscopy and spontaneous ventilation via LMA approach is a safe and effective option, especially in patients with limitations for rigid laryngoscopy and elevated BMI. LEVEL OF EVIDENCE Level Four (case series) Laryngoscope, 134:2672-2677, 2024.
Collapse
Affiliation(s)
- Liam Gallagher
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Soorya Todatry
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Kirsi Oldenburg
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Stephanie Misono
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Raluca Gray
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| |
Collapse
|
2
|
Sax L, Sharma S, Benedict J, Guy K, Mandybur I, Bittner M, Sinacori J, Rubinstein B. Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery. Laryngoscope 2024; 134:1343-1348. [PMID: 37724978 DOI: 10.1002/lary.31045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
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. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1343-1348, 2024.
Collapse
Affiliation(s)
- Leah Sax
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Shaan Sharma
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Jacob Benedict
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin Guy
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Ian Mandybur
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | | | - John Sinacori
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Benjamin Rubinstein
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| |
Collapse
|
3
|
Miller KM, Liang KY, Nero N, Benninger MS, Nelson RC, Tierney WS, Lorenz RR, Bryson PC. Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review. Laryngoscope 2024; 134:1014-1022. [PMID: 37632727 DOI: 10.1002/lary.30994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE There are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and anesthetic management of subglottic stenosis during pregnancy are not well described. DATA SOURCES MEDLINE, EMBASE, and the Cochrane databases. REVIEW METHODS A scoping review of management of subglottic stenosis during pregnancy was performed, and then reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted of those with subglottic or tracheal stenosis aged greater than 18 years, those in whom management was performed during pregnancy, and those who reported delivery related outcomes. RESULTS After systematic review and detailed search of 330 identified articles, 15 articles met inclusion criteria and were included in the final analysis. All studies were case reports or case series (level 4 evidence). This study identified 27 patients. The median age was 29 and the median gestational age at intervention was 28 weeks. Left lateral positioning and fetal heart rate monitoring were used in nearly every case. The most common intervention performed was endoscopic balloon dilation. In many cases, jet ventilation or transnasal humidified rapid insufflation ventilatory exchange was satisfactory for maintenance of the airway. Three women ultimately required tracheostomy prior to labor and delivery. There was no fetal death or complications reported in these studies, and all but one woman proceeded to deliver at term. CONCLUSION Endoscopic balloon dilation during pregnancy is safe and effective, resulting in optimized respiratory outcomes for the mother and safe delivery of the fetus. The third trimester appears to be safe for airway intervention. Laryngoscope, 134:1014-1022, 2024.
Collapse
Affiliation(s)
| | - Kevin Y Liang
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| | - Neil Nero
- Cleveland Clinic, Education Institute, Cleveland, Ohio, U.S.A
| | | | | | | | - Robert R Lorenz
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| | - Paul C Bryson
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| |
Collapse
|
4
|
Sharma V, Atluri H. Unveiling the Success of Awake Insertion of Supraglottic Airway Device for Ventilation in the Bronchoscopic Management of Tracheal Stenosis. Cureus 2024; 16:e54703. [PMID: 38524051 PMCID: PMC10960592 DOI: 10.7759/cureus.54703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/26/2024] Open
Abstract
Tracheal and subglottic stenoses are inflammatory conditions that can arise from a variety of potential etiologies, most commonly as a result of iatrogenic airway injury due to endotracheal intubation. Significant stenosis requires management by endoscopy or surgical resection. We describe a case of recurrent subglottic cuff stenosis with an episode of sudden desaturation in a 25-year-old female. The management involved balloon dilatation, laser ablation, and topical mitomycin C application through a flexible fiberoptic bronchoscope. Ensuring safe gas exchange during bronchoscopy was a priority, and this was achieved by maintaining ventilation with a supraglottic airway device, which was inserted in an awake patient after adequate tropicalization of the oral cavity. The intervention successfully helped in the management of stenosis and also addressed the complication of sudden complete airway collapse due to sedation.
Collapse
Affiliation(s)
- Vipul Sharma
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Harika Atluri
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| |
Collapse
|
5
|
Mangahas AM, Talugula S, Husain IA. Anesthesia considerations during management of airway stenosis: A systematic review. Am J Otolaryngol 2023; 44:103767. [PMID: 36586317 DOI: 10.1016/j.amjoto.2022.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the efficacy of ventilatory techniques by evaluating prevalence of technique failure and intraoperative hypoxia during endoscopic management of airway stenosis. DATA SOURCES A systematic review was conducted using PubMed and Embase for anesthesia techniques in endoscopic management of airway stenosis. REVIEW METHODS The primary outcome measured was reports of partial and complete technique failure. The secondary outcome measured was intraoperative hypoxia. RESULTS We identified 7704 abstracts with 17 meeting criteria for analysis. The reported partial and complete ventilatory technique failures were: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % laryngeal mask airway, 0 % nonocclusive balloon dilator, 4.76 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, and 30.24 % jet ventilation. The reported rate of intraoperative hypoxia was: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, 2.18 % jet ventilation, 3.57 % laryngeal mask airway, and 5 % nonocclusive balloon dilator. CONCLUSION Evone Flow-Controlled Ventilation with Tritube endotracheal tube had the lowest risk of technique failure and intraoperative hypoxia. Nonocclusive balloon dilator and laryngeal mask airway were also favorable techniques for ventilation. Jet ventilation showed a lower rate of intraoperative hypoxia, but a higher rate of failure. Newer techniques, such as Evone Flow-Controlled Ventilation with Tritube, nonocclusive balloon dilator and spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, may offer promise compared to older techniques like jet ventilation; however, larger studies with more uniform data are needed to determine their efficacy.
Collapse
Affiliation(s)
- Angelica M Mangahas
- University of Illinois College of Medicine - Rockford, 1601 Parkview Ave, Rockford, IL 61107, United States of America.
| | - Snehitha Talugula
- University of Illinois College of Medicine - Chicago, 1853 W Polk St, Chicago, IL 60613, United States of America
| | - Inna A Husain
- Community Hospital, Otolaryngology, 901 MacArthur Blvd, Munster, IN 46321, United States of America
| |
Collapse
|
6
|
Myint CW, Teng SE, Butler JJ, Griffeth JV, Fritz MA, Meiler SE, Postma GN. Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications. Ann Otol Rhinol Laryngol 2022; 131:1346-1352. [PMID: 35016557 DOI: 10.1177/00034894211072630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Manual jet ventilation is a specialized oxygenation and ventilation technique that is not available in all facilities due to lack of technical familiarity and fear of complications. The objective is to review our center's 15 year experience with low pressure low frequency jet ventilation (LPLFJV). METHODS Retrospective review of procedures utilizing LPLFJV from 2005 to 2019 were performed collecting patient demographic, surgery type and complications. Fisher exact test, Chi square, and t-test were used to determine statistical significance. RESULTS Four hundred fifty-seven patients underwent a total of 891 microlaryngeal surgeries-279 cases for voice disorders, 179 for lesions, and 433 for airway stenosis. The peak jet pressure for all cases did not exceed 20 psi and average peak pressure for the last 100 procedures in this case series was 14.9 ± 4.6 psi. The average lowest oxygen saturation for all cases was 95% ± 0.6%. Brief intubation was required in 154 cases (17%). Surgical duration was significantly longer for cases requiring intubation P < .001. The need for intubation was not associated with smoking or cardiopulmonary disease, but was strongly associated with body mass index (BMI). Intubation rates were 7% for normal weight (BMI < 25, N = 216), 13% for overweight (BMI 25-30, N = 282), 24% for obese (BMI 30-40, N = 342), and 37% for morbidly obese (BMI > 40, N = 52) patients. Three patients developed respiratory distress in the recovery unit and 2 patients required intubation. CONCLUSION LPLFJV assisted by intermittent endotracheal intubation is an exceedingly safe and effective intraoperative oxygenation and ventilationmodality for a broad variety of laryngeal procedure.
Collapse
Affiliation(s)
| | - Stephanie E Teng
- Department of Otolaryngology-Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jacline V Griffeth
- Department of Otolaryngology-Wake Forest Baptist Health. Winston-Salem, NC, USA
| | - Mark A Fritz
- Department of Otolaryngology-University of Kentucky, Lexington, KY, USA
| | - Steffen E Meiler
- Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, GA, USA
| | - Gregory N Postma
- Department of Otolaryngology, Augusta University, Augusta, GA, USA
| |
Collapse
|
7
|
Zheng M, Lui C, O'Dell K, M Johns M, Ference EH, Hur K. Aerosol Generation During Laryngology Procedures in the Operating Room. Laryngoscope 2021; 131:2759-2765. [PMID: 34213770 DOI: 10.1002/lary.29729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus-2 spreads through respiratory fluids. We aim to quantify aerosolized particles during laryngology procedures to understand their potential for transmission of infectious aerosol-based diseases. STUDY DESIGN Prospective quantification of aerosol generation. METHODS Airborne particles (0.3-25 μm in diameter) were measured during live-patient laryngology surgeries using an optical particle counter positioned 60 cm from the oral cavity to the surgeon's left. Measurements taken during the procedures were compared to baseline concentrations recorded immediately before each procedure. Procedures included direct laryngoscopy with general endotracheal anesthesia (GETA), direct laryngoscopy with jet ventilation, and carbon dioxide (CO2 ) laser use with or without jet ventilation, all utilizing intermittent suction. RESULTS Greater than 99% of measured particles were 0.3 to 1.0 μm in diameter. Compared to baseline, direct laryngoscopy was associated with a significant 6.71% increase in cumulative particles, primarily 0.3 to 1.0 μm particles (P < .0001). 1.0 to 25 μm particles significantly decreased (P < .001). Jet ventilation was not associated with a significant change in cumulative particles; when analyzing differential particle sizes, only 10 to 25 μm particles exhibited a significant increase compared to baseline (+42.40%, P = .002). Significant increases in cumulative particles were recorded during CO2 laser use (+14.70%, P < .0001), specifically in 0.3 to 2.5 μm particles. Overall, there was no difference when comparing CO2 laser use during jet ventilation versus GETA. CONCLUSIONS CO2 laser use during laryngology surgery is associated with significant increases in airborne particles. Although direct laryngoscopy with GETA is associated with slight increases in particles, jet ventilation overall does not increase particle aerosolization. LEVEL OF EVIDENCE III Laryngoscope, 2021.
Collapse
Affiliation(s)
- Melissa Zheng
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Christopher Lui
- University of Southern California, Keck School of Medicine, Los Angeles, California, U.S.A
| | - Karla O'Dell
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Michael M Johns
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Elisabeth H Ference
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Kevin Hur
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| |
Collapse
|
8
|
Pertile J, Smith B, Mellenthin M, Wagner J, DeBoer EM, Fink DS. Jet flow rate and needle position govern distal airway pressures during low-frequency jet ventilation. Laryngoscope Investig Otolaryngol 2021; 6:244-251. [PMID: 33869756 PMCID: PMC8035948 DOI: 10.1002/lio2.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/02/2020] [Accepted: 01/27/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Although jet ventilation is frequently used during surgery for airway stenosis, little is known about distal airway pressures during jet ventilation. The objective of the study is to determine how jet pressure, flow rate, and position of the ventilation needle relate to distal airway pressure magnitude and homogeneity. METHODS Two 3D models of the first five generations of the human airway tree were created. One is a duplicate of a human airway from a 15-year-old healthy male's computed tomography scan, and the other is an idealized symmetric model of human lung morphometry. Pressure transducers measured fifth-generation distal airway pressures in both models. A computer-controlled jet needle positioning system was used to ventilate the lung casts. The effects of jet needle position, jet pressure, and jet flow rate on distal airway pressure and homogeneity were measured. RESULTS Total entrained jet flow rate was the most reliable predictor of distal airway pressure. Pressure supplied to the jet ventilation needle had a positive linear relationship with distal airway pressure; however, this relationship was dependent on the jet needle flow resistance. As the ventilation needle moved closer to the tracheal wall, ventilation homogeneity decreased. Depth into the trachea was positively correlated with sensitivity of the needle to the tracheal wall. CONCLUSION In this model, total entrained jet flow rate is a more robust predictor of distal airway pressure than jet inlet pressure. More homogeneous ventilation was observed in our model with the ventilation needle centered in the proximal region of the trachea.
Collapse
Affiliation(s)
- Joshua Pertile
- Department of BioengineeringUniversity of Colorado DenverAnschutz Medical CampusAuroraColoradoUSA
| | - Bradford Smith
- Department of BioengineeringUniversity of Colorado DenverAnschutz Medical CampusAuroraColoradoUSA
- Department of Pediatrics, School of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Michelle Mellenthin
- Department of BioengineeringUniversity of Colorado DenverAnschutz Medical CampusAuroraColoradoUSA
- Department of Computer Science and EngineeringColorado Mesa UniversityGrand JunctionColoradoUSA
| | - Jennifer Wagner
- Department of BioengineeringUniversity of Colorado DenverAnschutz Medical CampusAuroraColoradoUSA
| | - Emily M. DeBoer
- Department of Pediatrics, School of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Daniel S. Fink
- Department of Otolaryngology, School of MedicineUniversity of ColoradoAuroraColoradoUSA
| |
Collapse
|
9
|
Rodney JP, Shinn JR, Amin SN, Portney DS, Mitchell MB, Chopra Z, Rees AB, Kupfer RA, Hogikyan ND, Casper KA, Tate A, Vinson KN, Fletcher KC, Gelbard A, St Jacques PJ, Higgins MS, Morrison RJ, Garrett CG. Multi-Institutional Analysis of Outcomes in Supraglottic Jet Ventilation with a Team-Based Approach. Laryngoscope 2021; 131:2292-2297. [PMID: 33609043 DOI: 10.1002/lary.29431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/11/2020] [Accepted: 01/10/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the safety and complications of endoscopic airway surgery using supraglottic jet ventilation with a team-based approach. STUDY DESIGN Retrospective cohort study. METHODS Subjects at two academic institutions diagnosed with laryngotracheal stenosis who underwent endoscopic airway surgery with jet ventilation between January 2008 and December 2018 were identified. Patient characteristics (age, gender, race, follow-up duration) and comorbidities were extracted from the electronic health record. Records were reviewed for treatment approach, intraoperative data, and complications (intraoperative, acute postoperative, and delayed postoperative). RESULTS Eight hundred and ninety-four patient encounters from 371 patients were identified. Intraoperative complications (unplanned tracheotomy, profound or severe hypoxic events, barotrauma, laryngospasm) occurred in fewer than 1% of patient encounters. Acute postoperative complications (postoperative recovery unit [PACU] rapid response, PACU intubation, return to the emergency department [ED] within 24 hours of surgery) were rare, occurring in fewer than 3% of patient encounters. Delayed postoperative complications (return to the ED or admission for respiratory complaints within 30 days of surgery) occurred in fewer than 1% of patient encounters. Diabetes mellitus, active smoking, and history of previous tracheotomy were independently associated with intraoperative, acute, and delayed complications. CONCLUSIONS Employing a team-based approach, jet ventilation during endoscopic airway surgery demonstrates a low rate of complications and provides for safe and successful surgery. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Jennifer P Rodney
- Department of Otolaryngology-Head and Neck Surgery, The Ear, Nose, Throat and Plastic Surgery Associates, Orlando, Florida, U.S.A
| | - Justin R Shinn
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Shaunak N Amin
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - David S Portney
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Margaret B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Zoey Chopra
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Andrew B Rees
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Alan Tate
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, U.S.A
| | - Kimberly N Vinson
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Kenneth C Fletcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Paul J St Jacques
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Michael S Higgins
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Robert J Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| |
Collapse
|
10
|
Pertile J, Mellenthin M, Wagner J, DeBoer EM, Fink D, Smith B. The Effects of Laryngoscope Shape and Needle Position on Distal Airway Pressure in Jet Ventilation. Laryngoscope 2020; 131:E354-E357. [PMID: 32717125 DOI: 10.1002/lary.28923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Laryngoscopes and subglottiscopes of multiple shapes and lengths are used in airway surgery to maintain an open airway; protect the trachea; and provide a place to mount the light, evacuator, and ventilation needle. Despite differences in scopes and ventilation needle mounting positions, the same jet pressures are typically used. We hypothesized that different scopes and scope configurations would affect distal airway pressure magnitude and homogeneity. STUDY DESIGN A laboratory investigation of distal airway pressures in a lung modelduring low frequency jet ventilation. METHODS A three-dimensional airway model based on the computed tomography scan of a 15-year old healthy male was fabricated with pressure transducers at the fifth airway generation. A laryngoscope and a subglottiscope were each mounted in the model coaxial with the trachea. Parameters including scope depth and needle mounting position were adjusted, and the effects on distal airway pressure were recorded. RESULTS Changing the scope depth from 1 to 3 cm past the laryngeal inlet had a limited effect on distal airway pressure. Needle mounting angle in the laryngoscope strongly influenced distal airway pressure, with a 7° angle change yielding a 67.5% increase. Compared to a loose needle centered in the trachea 1 cm past the laryngeal inlet, the subglottiscope and laryngoscope showed up to 16% and 150% increases in distal airway pressure, respectively. CONCLUSION Different scopes or changes in the configuration, such as the needle angle, strongly influence distal airway pressure. Our findings indicate that different jet pressures are required for different scopes and that a stable needle mount is a critical design consideration to prevent changes in minute ventilation due to needle movement. LEVEL OF EVIDENCE NA (Basic Research) Laryngoscope, 131:E354-E357, 2021.
Collapse
Affiliation(s)
- Joshua Pertile
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, U.S.A.,Department of Computer Science and Engineering, Colorado Mesa University, Grand Junction, Colorado, U.S.A
| | - Michelle Mellenthin
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, U.S.A.,Department of Computer Science and Engineering, Colorado Mesa University, Grand Junction, Colorado, U.S.A
| | - Jennifer Wagner
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Emily M DeBoer
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Daniel Fink
- Department of Otolaryngology, School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Bradford Smith
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, U.S.A.,Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| |
Collapse
|
11
|
Smeltz AM, Bhatia M, Arora H, Long J, Kumar PA. Anesthesia for Resection and Reconstruction of the Trachea and Carina. J Cardiothorac Vasc Anesth 2020; 34:1902-1913. [DOI: 10.1053/j.jvca.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022]
|
12
|
Heichel PD, Jacobsen CP, Llamas LL, Simpson CB, Lott DG, Verma S, Dominguez LM. Jet Ventilation in the Pregnant Patient with Airway Stenosis: Surgical Safety and Outcomes. Ann Otol Rhinol Laryngol 2019; 129:489-493. [PMID: 31867996 DOI: 10.1177/0003489419896598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review pregnancy outcomes and the safety of jet ventilation use in the gravid patient undergoing surgical airway intervention. METHODS A multi-institutional retrospective review of medical records was performed to identify women who underwent low-frequency jet ventilation during pregnancy for surgical treatment of airway stenosis. Postoperative complications were noted, and patients were interviewed regarding pregnancy outcomes. RESULTS Six women were included in this series. No immediate complications relating to anesthesia or surgical intervention were noted in five of the six women. One patient with a well-known history of uncontrolled seizures experienced seizure activity postoperatively. One patient returned to the operating room at a later date for debridement of tracheal crusts. Five mothers delivered via cesarean section and one via spontaneous vaginal delivery. The mean gestation age was 37.3 weeks. One of the six infants delivered prematurely and three were delivered at low birth weight. Three of the six infants required elevated care immediately post-delivery but, at present, all are in good health. CONCLUSION Low-frequency jet ventilation and surgical management of airway stenosis should be recognized as a safe treatment option in the gravid patient. Surgical intervention should not be delayed in patients with severe symptoms, particularly given the potential risk associated with prolonged corticosteroid use. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Philip D Heichel
- Department of Otolaryngology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Christian P Jacobsen
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Luis L Llamas
- Department of Anesthesiology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - C Blake Simpson
- Department of Otolaryngology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - David G Lott
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Sunil Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Laura M Dominguez
- Department of Otolaryngology, University of Texas Health San Antonio, San Antonio, TX, USA
| |
Collapse
|
13
|
Liang H, Hou Y, Sun L, Li Q, Wei H, Feng Y. Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial. BMC Anesthesiol 2019; 19:151. [PMID: 31409366 PMCID: PMC6693218 DOI: 10.1186/s12871-019-0821-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background Supraglottic jet oxygenation and ventilation (SJOV) can effectively maintain adequate oxygenation in patients with respiratory depression, even in apnea patients. However, there have been no randomized controlled clinical trials of SJOV in obese patients. This study investigated the efficacy and safety of SJOV using WEI Nasal Jet tube (WNJ) for obese patients who underwent hysteroscopy under intravenous anesthesia without endotracheal intubation. Methods A single-center, prospective, randomized controlled study was conducted. The obese patients receiving hysteroscopy under intravenous anesthesia were randomly divided into three groups: Control group maintaining oxygen supply via face masks (100% oxygen, flow at 6 L/min), the WNJ Oxygen Group with WNJ (100% oxygen, flow: 6 L/min) and the WNJ SJOV Group with SJOV via WNJ [Jet ventilator working parameters:100% oxygen supply, driving pressure (DP) 0.1 MPa, respiratory rate; (RR): 15 bpm, I/E; ratio 1:1.5]. SpO2, PETCO2, BP, HR, ECG and BIS were continuously monitored during anesthesia. Two-Diameter Method was deployed to measure cross sectional area of the gastric antrum (CSA-GA) by ultrasound before and after SJOV in the WNJ SJOV Group. Episodes of SpO2 less than 95%, PETCO2 less than 10 mmHg, depth of WNJ placement and measured CSA-GA before and after jet ventilation in the WNJ SJOV Group during the operation were recorded. The other adverse events were collected as well. Results A total of 102 patients were enrolled, with two patients excluded. Demographic characteristics were similar among the three groups. Compared with the Control Group, the incidence of PETCO2 < 10 mmHg, SpO2 < 95% in the WNJ SJOV group dropped from 36 to 9% (P = 0.009),from 33 to 6% (P = 0.006) respectively,and the application rate of jaw-lift decreased from 33 to 3% (P = 0.001), and the total percentage of adverse events decreased from 36 to 12% (P = 0.004). Compared with the WNJ Oxygen Group, the use of SJOV via WNJ significantly decreased episodes of SpO2 < 95% from 27 to 6% (P = 0.023), PETCO2 < 10 mmHg from 33 to 9% (P = 0.017), respectively. Depth of WNJ placement was about 12.34 cm in WNJ SJOV Group. There was no significantly difference of CSA-GA before and after SJOV in the WNJ SJOV Group (P = 0.234). There were no obvious cases of nasal bleeding in all the three groups. Conclusions SJOV can effectively and safely maintain adequate oxygenation in obese patients under intravenous anesthesia without intubation during hysteroscopy. This efficient oxygenation may be mainly attributed to supplies of high concentration oxygenation to the supraglottic area, and the high pressure jet pulse providing effective ventilation. Although the nasal airway tube supporting collapsed airway by WNJ also plays a role. SJOV doesn’t seem to increase gastric distension and the risk of aspiration. SJOV can improve the safety of surgery by reducing the incidence of the intraoperative involuntary limbs swing, hip twist and cough. Trial registration Chinese Clinical Trial Registry. Registration number, ChiCTR1800017028, registered on July 9, 2018.
Collapse
Affiliation(s)
- Hansheng Liang
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Yuantao Hou
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Liang Sun
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Qingyue Li
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China.
| |
Collapse
|