Jet Ventilation for ENT DL - please share your techniques?

[Laurel123]

Trying to make this whole thing more elegant? How do you guys do jet vent for direct laryngoscopies by ENT? How much pressure do you use and what rate?

Thanks

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[militarymd]

patient asleep and NMB administered.

Suspension done by surgeon.

Anesthesia maintained intravenously.

Aim jet down the tracheal and shoot oxygen down until there is good chest rise.....usually no more than 30 psi.

Other option is through nasal trumpet with mouth held close....but more likely to push air into the stomach.

 

[cchoukal]

When I was a med student on an ENT rotation, it seemed to me the ENTs had a special scope that allowed an attachement for the jet ventilator. This helped aim the jet stream right into the trachea without crowding the hypopharynx. Haven't seen this as a resident, though. Come to think of it, I've never had to do jet ventilation for ENT cases; we often just use a really small ETT and the surgeons seem to be able to get around it. Maybe our guys aren't doing the kind of work that requires the jet. What kinds of cases are these?

 

[VentdependenT]

Never used jet ventilation for ENT DL's.

We either use:1) Intermittent ventilation via mask or reintubation, 2) MLT- Microlaryngeal Tracheal Tube...havent even heard of this thing until my rotation at Childrens. Its a great device, 3) The port on the rigid bronch.

Propofol infusion + Sevo works well enough. Or just sevo. Whatever. Keep em spontaneously ventilating if possible. Smack em with sux if it gets too out of hand.

If you are adventureous then Propofol + Remi (or smidge of fentanyl). Hose the cords with some Lido for extra points. This doesn't ablate cough reflex, but perhaps lessens it.


Here is a nice little summary via Google:
http://ceaccp.oxfordjournals.org/cgi/content/full/6/1/28#TBL1

 

[DrDre']

In this era of cost-cutting, wouldn't it be a little too expensive to have Jet (Prop Pilot) there just for ventilation? He's also a little too bulky to further crowd up the head of the bed. If we are going to do this, we might as well have Vent(dependent) there too...

Never used jet ventilation for ENT DL's.

We either use:1) Intermittent ventilation via mask or reintubation, 2) MLT- Microlaryngeal Tracheal Tube...havent even heard of this thing until my rotation at Childrens. Its a great device, 3) The port on the rigid bronch.

Propofol infusion + Sevo works well enough. Or just sevo. Whatever. Keep em spontaneously ventilating if possible. Smack em with sux if it gets too out of hand.

If you are adventureous then Propofol + Remi (or smidge of fentanyl). Hose the cords with some Lido for extra points. This doesn't ablate cough reflex, but perhaps lessens it.


Here is a nice little summary via Google:
http://ceaccp.oxfordjournals.org/cgi/content/full/6/1/28#TBL1

 

[Dr Serenity]

In this era of cost-cutting, wouldn't it be a little too expensive to have Jet (Prop Pilot) there just for ventilation? He's also a little too bulky to further crowd up the head of the bed. If we are going to do this, we might as well have Vent(dependent) there too...

 

[Lonestar]

Trying to make this whole thing more elegant? How do you guys do jet vent for direct laryngoscopies by ENT? How much pressure do you use and what rate?

Thanks

We do it elegantly at our academic institution. ENT surgeons use laryngoscope blades with special connection for jet vent to directly blow oxygen down the trachea. I start with 0 and go up to 25 on jet vent pressure if necessary (most patients 15-20 psi). The key is to give rhythmic 2-3 sec jets so that there is sustained chest rise. If chest is not rising, be aware. ask the ENT to reposition the laryngoscope. The rate needs to be titrated according to pt. We run Propofol, remifentanyl, and succinylcholine infusions throught the case. we induce with propofol and succ then mask pt and turn the table over to ENT. continuous twitch monitoring helps titrate the succ drip. once the ENT are done, turn off all infusions and wake pt up. This technique is very tedious for just one person. You can just imagine when you have 8 of these cases in a day, and turnover is somewhat of an issue (academic institution). I barely get time to see the pt and we are off again.

 

[zippy2u]

How we runnit down at the 5 and dime ASC... 2 of dizzy daz,1cc of fent,Prop,sux(60mgs),LTA with 6.0 ETT. Throw on vent with air/ox and titrate with prop and sux(60mgs). No volatile agent, no BIS and no phase 2 blockade. Jet Ventilation?? WTF? ENT dudes work around the ETT. Booted out the PACU in 30 mins--coin show over.... Regards, ---Zip

 

[Laurel123]

In this era of cost-cutting, wouldn't it be a little too expensive to have Jet (Prop Pilot) there just for ventilation? He's also a little too bulky to further crowd up the head of the bed. If we are going to do this, we might as well have Vent(dependent) there too...

Ha!

 

[Laurel123]

We do it elegantly at our academic institution. ENT surgeons use laryngoscope blades with special connection for jet vent to directly blow oxygen down the trachea. I start with 0 and go up to 25 on jet vent pressure if necessary (most patients 15-20 psi). The key is to give rhythmic 2-3 sec jets so that there is sustained chest rise. If chest is not rising, be aware. ask the ENT to reposition the laryngoscope. The rate needs to be titrated according to pt. We run Propofol, remifentanyl, and succinylcholine infusions throught the case. we induce with propofol and succ then mask pt and turn the table over to ENT. continuous twitch monitoring helps titrate the succ drip. once the ENT are done, turn off all infusions and wake pt up. This technique is very tedious for just one person. You can just imagine when you have 8 of these cases in a day, and turnover is somewhat of an issue (academic institution). I barely get time to see the pt and we are off again.

Thanks! I used to do them in residency, but my attending would do the charting and draw up drugs while I played with the jet ventilater. Now that I am on my own, I use a technique similar to yours, though I actually just give 4 mg of Vecuronium which is reversible in 10-15 minutes, but it takes five minutes to work. It just reduces the amount of drips needed and monitering required when I just have two hands. Not as elagant. Ketafol drip and 100 mcg of fentanyl and 5 of versed. Esmolol for tachy. Paperwork after the case is over.