Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Lesion of the recurrent laryngeal nerves as a consequence of thyroid surgery results in bilateral vocal fold paralysis and respiratory obstruction. The initial treatment involves ensuring an adequate airway and it ranges from tracheostomy to endo-extralaryngeal laterofixating operations in general anesthesia. Subglottic high frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery. HFJV offers optimal endolaryngeal working conditions, immobility of vocal cords, adequate oxygenation and ventilation. The HFJV was prospectively studied in 20 consecutive female patients with bilateral vocal fold paralysis. Ventilation was performed as subglottic HFJV via jet catheter inserted through the vocal cord. Anesthesia was administered as total intravenous anesthesia. At the end of the procedure, the jet catheter was exchanged with LMA laryngeal mask until spontaneous breathing was established. Subglottic HFJV was used in 20 patients undergoing endo-extralaryngeal laterofixating operations with suspension microlaryngoscopy. The mean duration of surgery was 32.25 minutes, mean age 47.35 (SD 9.75) years, and mean body mass index 26.39 kg m-2 (SD 5.03). The mean arterial PaCO2 5 min before surgical procedure was 5.39 (SD 0.86) kPa, at 5 min of starting jet ventilation 6.19 (SD 0.91) kPa, and at the end of surgical procedure 5.93 (SD 0.99) kPa. There was significant correlation between PaCO2 obtained 5 min before starting jet ventilation and PaCO2 at 5 min of starting jet ventilation (p<0.05). No complications secondary to the ventilation technique were observed. No perioperative tracheotomy was necessary. It is concluded that subglottic HFJV is an easy and safe way to ventilate patients with bilateral vocal fold paralysis when endoscopic intervention is performed.Obostrana pareza glasnica s posljedičnom opstrukcijom dišnoga puta nastaje kao rezultat lezije rekurentnog laringealnog živca tijekom operacije štitne žlijezde. Inicijalni postupci kojima se osigurava dišni put kod ovih bolesnika uključuju različite endo-ekstralaringealne zahvate te samu traheotomiju, koji se izvode u općoj anesteziji. Subglotična visokofrekventna jet ventilacija (VFJV) je alternativna tehnika ventilacije koja se koristi u kirurgiji dišnog puta. Ova tehnika ventilacije pruža optimalne endolaringealne uvjete za kirurški rad. U ovoj prospektivnoj studiji VFJV se rabio kod 20 bolesnica s obostranom parezom glasnica. Subglotična VFJV je provedena preko jet katetera postavljenog između glasnica u totalnoj intravenskoj anesteziji. Na kraju operacije je jet kateter zamijenjen laringealnom maskom sve do uspostavljanja spontanog disanja. Tehnika subglotične VFJV je upotrijebljena kod 20 bolesnica podvrgnutih endo-ekstralaringealnoj laterofiksaciji u suspenzijskoj mikrolaringoskopiji. Srednje vrijeme kirurške intervencije je bilo 32,25 minuta, srednja dob bolesnica 47,35 (SD 9,75) godina i srednji indeks tjelesne mase 26,39 (SD 5,03) kg m-2. Srednja vrijednost PaCO2 5 minuta prije početka kirurške intervencije je bila 5,39 (SD 0,86) kPa, 5 minuta nakon primjene jet ventilacije 6,19 (SD 0,91) kPa, a na kraju kirurške intervencije 5,93 (SD 0,99) kPa. Uočena je značajna korelacija između vrijednosti PaCO2 dobivenih 5 minuta prije početka kirurške intervencije i 5 minuta nakon početka primjene jet ventilacije (p<0,05). Komplikacije vezane za primjenu VFJV nisu primijećene. Tijekom perioperacijskog razdoblja nije bilo potrebe za traheotomijom. U zaključku, subglotična VFJV je sigurna tehnika ventilacije koja se primjenjuje tijekom endoskopskih intervencija kod bolesnika s obostranom parezom glasnica
