This blog describes a practical procedure in which jet ventilation was used. This example took place in an academic hospital in the Netherlands. Superimposed High Frequency Jet ventilation was applied via a jet laryngoscope.
During these procedures, it is of great importance that the surgeon and anesthesiologist cooperate well with each other. After all, the ENT surgeon uses the laryngoscope directly in the ventilation channel, which is the anesthesiologist’s field of work. If, for example, a problem arises with gas exchange, the positioning of the scope may need to be adjusted. Good communication between surgeon and anesthesiologist is essential.
Start of procedure
In the patients of the practical examples, the anesthesia is administered with the help of a propofol and remifentanil pump. The relaxation of the patients is by means of esmeron. In addition to standard monitoring, a TOF is also connected, BIS is used and CO₂ is measured transcutaneously. Because jet ventilation can contribute to cooling, the patients receive a warming blanket and the temperature is regularly measured via the ear. The patients also receive heated bias flow 20 L/min.
In case of a power failure, there is a battery that may provide the TwinStream with emergency power. The TwinStream is linked to PDMS. The jet and monitor tubes used can be disposable or reusable. The humidifier heats and humidifies the jet flow.
Laryngeal surgery in a 9-year-old child
The initial settings in the OR for a 9-year-old female of 30 kg are: NF 16x, HF 600x, i:e 1:1.5 and Peep 0.9 bar NF and 0.7 bar HF. O₂ 80%. A Biasflow of 20 l/min. During lasering, the HF goes to 1500 and the laser safe mode (LSM) turns on with O₂ of 40%. Saturation is good during this phase.
The ENT surgeon intubates the scope and also connects the jet tubes. After positioning the scope, dental protection is applied and the head is placed in the “sniffing position”.
In the course of the OR, the HF-peep goes to 0.5 and even now everything remains stable and the measured CO₂ is also up to standard. The anesthesiologist is constantly in the OR. The ENT surgeon communicates well with anesthesia: “is the O₂ low? I want to start lasering”. It is nice for the ENT surgeon to have a clear OR field. It would also work with a thin tube, but that does not make the work any easier. Sometimes you cannot get the scope properly aimed and the effect of the jet stream is not sufficient. Then, depending on many factors, it will be determined whether to intubate or whether a combination of intubation and jetting takes place, or perhaps another method.
The procedure lasted about 25 minutes. After the procedure, the patient is extubated and goes to the recovery room able to speak. A successful procedure without any complications.
