[Ventilation during tracheotomy in extensive, 90% laryngeal stenosis using superimposed high frequency jet...

In a 35-year old male patient with laryngeal carcinoma an acute respiratory insufficiency with early hypoxaemia developed due to massive laryngeal stenosis. An endotracheal intubation was not possible since the available lumen was too small. Tracheotomy using local anaesthesia was not possible since spontaneous respiration with a Venturi mask applying 100% oxygen was not sufficient and the patient was becoming restless and agitated due to the hypoxaemia. Transcutaneous jet ventilation was considered to be too risky since the needle would have to pass highly vascularised tumour tissue and the detection of such a small rest lumen would have been quite difficult. Ventilating the patient using a percutaneous catheter would have been very risky as well since, due to the massive stenosis, a sufficient expiration would not be likely and therefore was considered to carry a high risk of barotrauma. The patient was ventilated under general anaesthesia via a specially designed endoscopy tube with integrated jet nozzles applying superimposed high frequency jet ventilation above the stenosis. Since it was possible to achieve sufficient ventilation during the inspection of the larynx the jet laryngoscope was left in place and the supporting apparatus was covered with sterile drapes. The tracheotomy was performed using the superimposed high frequency jet ventilation. Throughout the procedure oxygenation and ventilation were adequate. The laryngectomy performed several days later revealed a cauliflower type protrusion into the tracheal lumen and a 5 cm long stenosis of the larynx with a lumen of 3 mm.