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Successful management of a patient with massive vocal fold granuloma with transglottal jet ventilation.

Kim J, Sun JM, Kim CK, Min NH, Park WK - Korean J Anesthesiol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

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We therefore decided to perform transtracheal jet ventilation (TTJV) using a percutaneous transtracheal catheter... We changed our plan to transglottal jet ventilation instead of transtracheal ventilation, and a hard and long catheter (ID: 2 mm, OD: 3 mm, length: 50 cm) was inserted though the glottic opening... Because the mass was soft and friable, it could not be extracted in one step, so it was removed piecemeal instead... To minimize interruptions to the extraction process, we reduced the respiration rate as low as possible while watching the patient's SpO2 level on the pulse oximeter... After removing all of the vocal fold granuloma, we found that the angiocatheter was located very close to the rear wall of the trachea... The patient was then extubated and, simultaneously, the 16 gauge angiocatheter was removed from the neck... The subatmospheric pressure generated by the jet just below the larynx would force the mass toward the glottic opening, resulting in total airway obstruction... However, even with a massive laryngeal tumor causing severe inspiratory obstruction, adequate expiratory flow is possible because of the "ball-valve" effect of most laryngeal masses... Immediately after jet injection, we observed that the mass and some blood were discharged out of the glottis... Although the Venturi principle may produce a small suction effect at the start of the inspiratory phase, this is rapidly negated by an upward flow of gas through the larynx as pressure rises high in the trachea after injection... The high intra-tracheal pressure caused by the jet ventilation appears to lift the mass up and open the obstructed glottis, allowing for better visualization.

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Related in: MedlinePlus

An endoscopic view of the 3 × 3 cm-sized vocal cord granuloma. The arrow indicates a narrow glottic opening. G: granuloma. Used with permission from the patient.
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Figure 1: An endoscopic view of the 3 × 3 cm-sized vocal cord granuloma. The arrow indicates a narrow glottic opening. G: granuloma. Used with permission from the patient.

Mentions: A 50-year-old man weighing 48 kg was admitted to the hospital after suffering breathing difficulty and hoarseness for two weeks. During endoscopic examination, a squishy mass that occupied 80-90% of the glottic opening was observed (Fig. 1). The stalk was located on the left side just above the vocal cords and it moved slightly in and out of the glottis when the patient breathed. The patient entered the operating room in a sitting position and was given 100% oxygen with a nasal prong. Once on the operating table, the patient was placed in the semi-Fowler's position. It was anticipated that when he lost consciousness from anesthesia induction, mask ventilation would no longer work due to his totally obstructed airway. We therefore decided to perform transtracheal jet ventilation (TTJV) using a percutaneous transtracheal catheter.


Successful management of a patient with massive vocal fold granuloma with transglottal jet ventilation.

Kim J, Sun JM, Kim CK, Min NH, Park WK - Korean J Anesthesiol (2014)

An endoscopic view of the 3 × 3 cm-sized vocal cord granuloma. The arrow indicates a narrow glottic opening. G: granuloma. Used with permission from the patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4295962&req=5

Figure 1: An endoscopic view of the 3 × 3 cm-sized vocal cord granuloma. The arrow indicates a narrow glottic opening. G: granuloma. Used with permission from the patient.
Mentions: A 50-year-old man weighing 48 kg was admitted to the hospital after suffering breathing difficulty and hoarseness for two weeks. During endoscopic examination, a squishy mass that occupied 80-90% of the glottic opening was observed (Fig. 1). The stalk was located on the left side just above the vocal cords and it moved slightly in and out of the glottis when the patient breathed. The patient entered the operating room in a sitting position and was given 100% oxygen with a nasal prong. Once on the operating table, the patient was placed in the semi-Fowler's position. It was anticipated that when he lost consciousness from anesthesia induction, mask ventilation would no longer work due to his totally obstructed airway. We therefore decided to perform transtracheal jet ventilation (TTJV) using a percutaneous transtracheal catheter.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

We therefore decided to perform transtracheal jet ventilation (TTJV) using a percutaneous transtracheal catheter... We changed our plan to transglottal jet ventilation instead of transtracheal ventilation, and a hard and long catheter (ID: 2 mm, OD: 3 mm, length: 50 cm) was inserted though the glottic opening... Because the mass was soft and friable, it could not be extracted in one step, so it was removed piecemeal instead... To minimize interruptions to the extraction process, we reduced the respiration rate as low as possible while watching the patient's SpO2 level on the pulse oximeter... After removing all of the vocal fold granuloma, we found that the angiocatheter was located very close to the rear wall of the trachea... The patient was then extubated and, simultaneously, the 16 gauge angiocatheter was removed from the neck... The subatmospheric pressure generated by the jet just below the larynx would force the mass toward the glottic opening, resulting in total airway obstruction... However, even with a massive laryngeal tumor causing severe inspiratory obstruction, adequate expiratory flow is possible because of the "ball-valve" effect of most laryngeal masses... Immediately after jet injection, we observed that the mass and some blood were discharged out of the glottis... Although the Venturi principle may produce a small suction effect at the start of the inspiratory phase, this is rapidly negated by an upward flow of gas through the larynx as pressure rises high in the trachea after injection... The high intra-tracheal pressure caused by the jet ventilation appears to lift the mass up and open the obstructed glottis, allowing for better visualization.

No MeSH data available.


Related in: MedlinePlus