title: Elective use of an uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway.
abstract: OBJECTIVE
  To conduct a qualitative observational study on positive pressure ventilation through a percutaneous uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway to minimize supraglottic leak.
  
  
  METHODS
  Ten consecutive procedures were performed in the nine men enrolled in this study. The demographics of the participants were: aged 50-73 yr, weight 48-87 kg, American Society of Anesthesiologists class I-II, and scheduled for endoscopic submucosal dissection via flexible endoscopy for en bloc resection of superficial meso- and hypopharyngeal cancer. The airway was initially secured with a supraglottic airway (SGA) under sevoflurane-based anesthesia, and a cricothyrotomy was then performed using a Portex(®) Minitrach II uncuffed cricothyrotomy tube (4-mm internal diameter). Following SGA removal, a Coopdech(®) bronchial blocker was orally or nasally inserted, and the balloon was inflated to occlude the trachea immediately beneath the glottis. The ventilator setting was initially based on observation of chest motion and end-tidal carbon dioxide tension and then readjusted according to arterial blood gas levels. All procedures were completed within a median time of 149 min. Effective ventilation was achieved in all patients despite mild hypercapnia (PaCO2 of 58 mmHg at maximum) in some patients. SpO2 levels were maintained at ≥ 98%.
  
  
  CONCLUSIONS
  This technique provides effective intraoperative ventilation and easy endoscopic access, and it countermeasures against the likely complication of postoperative laryngeal edema. Moreover, there is no need for conventional tracheostomy or prolonged intubation. This approach establishes a curative and less invasive pharyngeal cancer therapy. Certain adverse outcomes can be avoided, including impaired speech and swallowing, possible delayed closure of the stoma, or a compromised cosmetic outcome.
authors.affiliation: Department of Anesthesia, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan, tksuzuki@med.showa-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Haruo
authors.initials: H
authors.lastname: Ikeda
authors.forename: Taito
authors.initials: T
authors.lastname: Iwamoto
authors.forename: Hitomi
authors.initials: H
authors.lastname: Sano
authors.forename: Megumi
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Katsunori
authors.initials: K
authors.lastname: Oe
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Serada
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D001784:Blood Gas Analysis; D003413:Cricoid Cartilage / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005931:Glottis; D006801:Humans; D006935:Hypercapnia / Q000453:epidemiology; D007819:Laryngeal Edema / Q000517:prevention & control; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D000077149:Sevoflurane; D013957:Thyroid Cartilage / Q000601:surgery
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D010100:Oxygen