[Tube-free translaryngeal superposed jet ventilation]

Microsurgical operations on the larynx require sufficient space for the surgeon in order to achieve the best surgical result. After preliminary experimental studies we integrated two jets of a specific size into the Kleinsasser tube. Simultaneously, we developed a "superimposed jet-ventilation system", which consists of a low-frequency jet ventilation and superimposed high-frequency jet ventilation. Respiration was maintained with a mixture of oxygen and air, whereby an additional increase in air and volume via the Kleinsasser tube, which is open on the outside, can be sustained on account of the Venturi effect. We tested this tubeless translaryngeal superimposed jet-ventilation system in 48 patients. Anesthesia was carried out by continuous intravenous administration of Propofol and intermittent doses of Sufentanil and Vecuronium as required. The clinical results showed optimal ventilation without hypercapnia. The arterial pC0(2) levels were below 42 mmHg. The arterial p0(2) levels were above 120 mmHg with a FIO2 of 40%. No complications were observed with regard to respiration during any of the operations. The surgeon had optimal conditions to carry out the operation. Because of the absence of a plastic tube, inhalation anesthetics and nitrous oxide, laryngeal laser surgery is another field of application for which this form of tubeless jet ventilation is excellently suited. We tested it with 12 patients, and no complications due to laser anesthesia were observed. We consider this form of a tubeless superimposed translaryngeal jet ventilation to be a great improvement in microlaryngeal surgery.