[Use of high-frequency jet ventilation in vertical partial surgery of the larynx]

High-frequency jet-ventilation (HFJV) was applied to 30 patients undergoing vertical partial surgery of the larynx for carcinoma of the vocal cords. This technique gave good surgical conditions as it interfered little with the air-ducts. It was carried out with a catheter of only 3 mm external diameter; control of ventilation during surgery was adequate, the average PaO2 being 27.9 +/- 5.6 kPa (209.3 +/- 4.2 mmHg) and the average PaCO2 5.4 +/- 1.4 kPa (40.5 +/- 10.5 mmHg). It avoided also the need for a tracheotomy. In the past, anaesthetic techniques were local anaesthesia combined with neuroleptanalgesia, endotracheal intubation or preoperative tracheotomy. None of these methods being satisfactory, our practice now includes first a nasotracheal intubation with an armoured tube at the beginning of the surgical procedure, followed by HFJV during the removal of the vocal cord, the tracheal tube being slightly pulled out. The tracheal tube is then put back in place before the thyroid cartilage is closed. The contra-indications are the same as those of HFJV. There are two types of complications: complications of HFJV itself, and postoperative complications due to the absence of tracheotomy. No accidents were observed. The only incidents seen were related to the lack of tracheotomy: subcutaneous oedema of the neck during the postoperative period in eight patients and moderate tracheobronchial congestion in five patients.