Hardy M J, Huard C, Lundblad T C
William Beaumont Hospital, Royal Oak, Mich., USA.
AANA J. 2000 Jun;68(3):241-4.
Jet ventilation (JV) involves high-pressure ventilation for upper laryngeal laser procedures. Anesthetic management for the patient undergoing JV can be challenging, as complications of JV can include subcutaneous emphysema and tension pneumothorax. A 52-year-old woman with a diagnosis of vocal cord polyps presented for direct microlaryngoscopy and laser laryngoplasty with JV. Intraoperatively, the patient developed lack of bilateral chest movement and an audible change in jet-ventilatory sounds. The patient was reintubated with a standard endotracheal tube. Subsequent attempts to ventilate the patient failed. A diagnosis of bilateral tension pneumothorax was made. Immediate pleural decompression resulted in improved ventilatory and hemodynamic status. The purpose of this case report is to discuss the pathophysiology related to tension pneumothorax and anesthetic implications for management of cases involving JV.
喷射通气（JV）用于上喉部激光手术的高压通气。接受JV治疗的患者的麻醉管理可能具有挑战性，因为JV的并发症可能包括皮下气肿和张力性气胸。一名诊断为声带息肉的52岁女性接受直接显微喉镜检查和JV激光喉成形术。术中，患者出现双侧胸部活动缺失以及喷射通气声音的可闻变化。患者重新插入标准气管内导管。随后对患者进行通气的尝试失败。诊断为双侧张力性气胸。立即进行胸膜减压使通气和血流动力学状态得到改善。本病例报告的目的是讨论与张力性气胸相关的病理生理学以及对涉及JV病例管理的麻醉影响。
