Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington 98195, USA.
Laryngoscope. 2012 Oct;122(10):2234-9. doi: 10.1002/lary.23491. Epub 2012 Aug 2.
OBJECTIVE/HYPOTHESIS: The Hunsaker Mon-Jet tube (HMJT) (Xomed, Jacksonville, FL) has been used effectively for subglottic ventilation. We previously reported a series of 552 patients over a 10-year period with no major complications. This is a continuation of that series with an additional 5 years of cases.
Retrospective consecutive case series.
Patients who were ventilated with the HMJT for microlaryngeal surgery at the University of Washington Medical Center over a 15-year period (1995-2010) were identified from the Voice Disorders database. Charts were reviewed for demographic data, laryngeal diagnosis, and anesthetic parameters. Main outcome measure was the rate of complications.
Fifty-seven complications occurred in 49 cases out of 839 cases (5.8% complication rate). In descending order, the complications were hypoxia (SpO(2) <90%, n = 30, 3.6%), hypercarbia (end tidal CO(2) of >60 mm Hg, n = 17, 2.0%), airway obstruction (n = 4, 0.5%), barotrauma (n = 2, 0.2%), seeding of blood into trachea (n = 2, 0.2%), submucosal injection of air (n = 1, 0.1%), and mucosal damage (n = 1, 0.1%). Factors associated with complications included high body mass index (P = .04), American Society of Anesthesiology class III or IV (P = .01), history of heart disease (P = .02), history of previous laryngeal surgery (P = .02), longer duration of case (P = .006), and laser use (P = .005).
Although subglottic ventilation via an HMJT is a safe alternative to traditional endotracheal intubation in an appropriately selected population, practitioners should remain vigilant about the known complications.
目的/假说：胡萨克 Mon-Jet 管（HMJT）（Xomed，杰克逊维尔，佛罗里达州）已被有效地用于声门下通气。我们之前报告了一个 10 年期间的 552 例患者系列，没有出现重大并发症。这是该系列的延续，增加了另外 5 年的病例。
回顾性连续病例系列。
从华盛顿大学医学中心的语音障碍数据库中确定了在 15 年期间（1995-2010 年）使用 HMJT 进行显微喉镜手术的患者。对图表进行了回顾，以获取人口统计学数据、喉部诊断和麻醉参数。主要观察指标为并发症发生率。
在 839 例病例中，有 49 例发生了 57 例并发症（5.8%的并发症发生率）。按降序排列，并发症为缺氧（SpO2<90%，n=30，3.6%）、高碳酸血症（呼气末 CO2>60mmHg，n=17，2.0%）、气道阻塞（n=4，0.5%）、气压伤（n=2，0.2%）、血液播散到气管（n=2，0.2%）、黏膜下空气注射（n=1，0.1%）和黏膜损伤（n=1，0.1%）。与并发症相关的因素包括高体重指数（P=0.04）、美国麻醉医师协会（ASA）III 或 IV 级（P=0.01）、心脏病史（P=0.02）、既往喉部手术史（P=0.02）、手术时间较长（P=0.006）和激光使用（P=0.005）。
尽管在适当选择的人群中，通过 HMJT 进行声门下通气是传统气管内插管的安全替代方法，但医生仍应警惕已知的并发症。
