Jet ventilation in a case of tracheal obstruction secondary to a retrosternal goitre

Intermittent jet ventilation was used during anaesthesia in a 66-yr-old woman who had severe tracheal narrowing secondary to compression by a retrosternal goitre. The trachea was intubated by a small-bore tube, which was placed above the site of narrowing. An injector was connected to the proximal end of the tracheal tube on one side and to the anaesthesia circuit on the other. Intermittent jets of 66% nitrous oxide in oxygen via the injector resulted in adequate oxygenation and carbon dioxide elimination. Arterial blood gas analysis during jet ventilation showed PaO2 150 mmHg, PaCO2 35 mmHg and pH 7.4. It is concluded that low-frequency jet ventilation may provide adequate oxygenation and carbon dioxide elimination in the presence of tracheal narrowing.