Combined use of high-frequency jet ventilation and abdominal lift for laparoscopic cholecystectomy in a patient with glottic impairment.
Effective airway management during laparoscopic anesthesia is important to minimize the adverse consequences of the carbon dioxide (CO2) pneumoperitoneum (PP). During PP, reduced respiratory excursion and tidal volumes with increased CO2 absorption may lead to hypoxia, hypercapnia, and respiratory acidosis. Although these problems can usually be avoided by use of positive pressure ventilation and an endotracheal tube, patients with a restricted airway who cannot be intubated pose a unique challenge. High-frequency jet ventilation (HFJV) has been described as an alternative to endotracheal intubation in other settings. The use of the small-diameter jet tube allows relatively unobstructed access to the larynx during laryngeal surgery. In patients with glottic impairment related to vocal fold immobility, jet ventilation allows positive pressure ventilation without the use of an endotracheal tube or tracheostomy in cases where lung and diaphragmatic compliance permit adequate excursion for ventilation and glottal diameter permits an adequate outflow of air. In this report, we describe the successful use of HFJV combined with an abdominal lifting technique and low-pressure PP for laparoscopic surgery in a patient with glottic compromise related to vocal fold immobility. Using these techniques, a laparoscopic cholecystectomy was performed successfully without endotracheal intubation or the need for a tracheostomy.
Barreca
M
M
Department of Surgery, University of Washington School of Medicine, 1959 N.E. Pacific Street, Seattle, WA 98195-6410, USA.
Maronian
N
N
Bowdle
T A
TA
Sinanan
M N
MN
D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D005260:Female; D005931:Glottis; D006611:High-Frequency Jet Ventilation; D006801:Humans; D007829:Laryngostenosis / Q000150:complications; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000150:complications