Transtracheal Ventilation for Laryngoscopy

Abstract

The use of transtracheal ventilation during laryngoscopy is reported in a 66-year-old female. Indirect laryngoscopy prior to admission to the hospital revealed a deeply ulcerating and destructive lesion of the entire right side of the epiglottis with the entire right hemilarynx fixed. The technique of ventilation through a No. 16 Teflon® intravenous catheter placed into the trachea below the first tracheal ring is described. The patient was anesthetized with sodium thiamylal and paralyzed with succinylcholine. Ventilation of the lungs was with an intermittent jet of oxygen under high pressure (50 lbs/sq in). The indications for the use of this technique are described together with the possible hazards. Transtracheal ventilation may have an important role in cardiopulmonary resuscitation and in ventilation during anesthesia. It may be of particular value in the patient with a partially obstructive lesion of the larynx such as a carcinoma in whom standard tracheal intubation with an endotracheal tube would be difficult. However, in patients who are in respiratory distress with an obstructive lesion of the larynx, there may be some problems in exhalation. If this occurs, a cricothyrotomy may be performed for exhalation or an attempt should be made to open the upper airway, perhaps with a small bronchoscope. It should be emphasized that a dangerously high airway pressure may also occur with a prolonged inspiratory phase with the high pressure oxygen.