The difficult airway: the use of subglottic jet ventilation for laryngeal surgery

High-frequency subglottic jet ventilation was used in 352 cases of adults treated with suspension microlaryngoscopy. Of these, 89 had difficult airways, and these are the subject of this manuscript. All cases were managed by the senior anaesthesiologist (AP) and the senior surgeon (JR), between 2000 and 2004. There were minimal complications associated with this technique in this series. The subglottic catheter never proved impossible to insert, and was used on one occasion in a rescue mode after supraglottic jetting led to oxygen desaturation. Body habitus did not prevent use of the technique in this series. There were only 3 instances in the entire series (n=352) of cases requiring replacement by the supraglottic catheter due to limitation of visualization of the posterior glottis. The technique was used in a wide variety of surgical pathology, from benign hyperfunction-related laryngeal pathology, through paralytic vocal fold conditions, papilloma, granuloma, dysplasia and malignancy. Advantages and disadvantages over traditional intubation techniques and supraglottic jet ventilation are reviewed, including such issues as: ease of intubation/ventilation; surgical exposure/control; maintenance of O(2) and CO(2) levels; use in the limited/borderline airway.