TITLE:
High Frequency Transcricoid Jet Ventilation Prior to Neck Surgery—A 10-Year Retrospective Case Series Analysis
AUTHORS:
Hille Kisch-Wedel, Hannelore Ledderose, Kathrin Reise, Bernhard Zwissler
KEYWORDS:
Jetventilation, Transcricoid, Difficult Airway
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.10 No.1,
January
21,
2020
ABSTRACT: Difficult airway is still a challenging field in anesthesia, emergency departments and intensive care unit and is the cause of severe patient injury such as irreversible hypoxic brain damage or even death. Therefore, safer techniques are needed to maintain the airway in patients, who are difficult to intubate. The aim was to analyze the safety of the technique of transcricoid high frequency jetventilation (TCHFJV) by the investigation of complications. We performed a 10-year retrospective analysis (1/2009-1/2019) of patients subjected to TCHFJV at the hospital of the Ludwigs-Maximilians-University, Munich, Germany. TCHFJV was applied before anesthesia induction in awake, spontaneously breathing patients, with suspected or known difficult airway, scheduled for head and neck surgery. During the 10-year study period, we identified 39,477 patients, who underwent neck surgery. Of these, 1489 (3.8%) patients were managed with TCHFJV (1090 males, 399 females; 62 ± 13 years, BMI 25 ± 0.2 kg?m-2, ASA class 3 ± 0.5). TCHFJV was successful in 1479 (99%) patients. Subsequent endotracheal intubation was performed in most cases (93%). Occasionally, emergency cricothyroidotomy (n = 2) or tracheotomy (n = 6) was necessary following TCHFJV. TCHFJV-related complications occurred in 1.5% of the cases. A majority (83%) of the complications were judged to be non-severe (grade 1, 2A) and 17% were severe (grade 3B), while there were none that were very severeC or lethalD. This retrospective study indicates that TCHFJV in experienced hands is a relatively safe alternative airway management strategy for patients undergoing neck surgery.