Anesthesia in acute respiratory tract obstructions caused by high degree laryngeal and tracheobronchial stenoses]

Stenotic process of the laryngeal and/or tracheobronchial system may lead to dyspnoea which can become life threatening.The object of our study was to determine whether sufficient gas exchange can be ensured in patients with a massive stenosis of the respiratory tract applying the Superimposed High-Frequency-Jet-Ventilation (SHFJV) via the jet laryngoscope. Further, it was to be determined whether SHFJV can be applied for insertion of endoluminal stents into the tracheo-bronchial system.SHFJV was applied using the Bronchotron-ventilator (capable of generating simultaneous low frequency and high frequency jets) and the laryngoscope, basically a modified endoscopy tube permitting simultaneous application of two jet modes. SHFJV was performed in 14 patients (including 4 children) suffering from massive laryngeal stenosis and in further 12 patients with stenosis of the tracheo-bronchial system. In all patients total intravenous anaesthesia was performed.In the patients with laryngeal stenosis the average paO2 was 117.5 +/- 43 mmHg, and the mean paCO2 47.3 +/- 11.6 mmHg. In the patients with stenosis of the tracheo-bronchial system the mean paO2 was 125 +/- 77 mmHg and the average paCO2 53.3 +/- 18 mmHg.The SHFJV technique presents the possibility to ventilate the patients continuously for surgical procedures even with massive stenosis of the respiratory tract. The application of SHFJV via the jet laryngoscope not only enables the anaesthesist to ventilate this group of patients but also helps the surgeon and therefore results in more safety for the patient.