A new anesthetic system for microlaryngeal surgery.

Anesthesia for microlaryngeal surgery creates many obstacles for the anesthesiologist and otolaryngologist. Anesthetic techniques developed to improve surgical exposure have been met with significant limitations and are difficult for the anesthesiologist to monitor. A new subglottic jet ventilation anesthesia system is introduced that meets the needs of the otolaryngologist and the anesthesiologist. This new system is made up of two components: (1) The Hunsaker Mon-Jet tube is a laser-safe, subglottic jet ventilation tube constructed of a nonflammable fluoroplastic material. It allows monitoring of tracheal pressure and end tidal carbon dioxide, and it is designed with a basket-shaped distal extension to align the jet port away from the tracheal mucosa and to prevent trauma and submucosal injection of jetted gas. (2) An automatic jet ventilator, which has an adjustable respiratory rate, inspiratory/expiratory ratio, and flow rate, also monitors expiratory end peak airway pressures and has an automatic shutdown feature if either of these pressures are exceeded. This system was successfully used in 36 patients undergoing microlaryngeal surgery.