Effect of Increased Body Mass Index on Complication Rates during Laryngotracheal Surgery Utilizing Jet Ventilation.

Objective Jet ventilation has been used for >30 years as an anesthetic modality for laryngotracheal surgery. Concerns exist over increased risk with elevated body mass index (BMI). We reviewed our experience using jet ventilation for laryngotracheal stenosis to assess for complication rates with substratification by BMI. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods A total of 126 procedures with jet ventilation were identified from October 2006 to December 2014. Complications were recorded, including intubation, unplanned admission, readmission, dysphonia, oral trauma, pneumothorax, pneumomediastinum, and tracheostomy. Lowest intraoperative oxygen saturation and maximum end-tidal CO2 (ETCO2) levels were recorded. Results Among 126 patients, 43, 77, and 6 had BMIs of <25, 25-35, and 36-45, respectively. In the BMI <25 group, there was 1 unplanned intubation. Mean maximum ETCO2 was 36.51 with no hypoxemia observed. In the BMI 25-35 group, 2 patients required intubation, and 1 sustained minor oral trauma. The mean maximum ETCO2 was 38.85, with 4 patients having oxygen saturation <90%. In the BMI 36-45 group, 2 patients required intubation. The mean maximum ETCO2 was 41 with no hypoxemia observed. BMI and length of stenosis were statistically significant variables associated with incidence of intraoperative intubation. Conclusion Increased BMI was associated with an increase in highest ETCO2 intraoperatively. However, this was not associated with an increase in major complications. Jet ventilation was performed without significant adverse events in this sample, and it is a viable option if used with an experienced team in the management of laryngotracheal stenosis.

Safety and efficacy of laryngeal mask airway ventilation in obese patients with airway stenosis.

OBJECTIVE: To assess the efficacy of laryngeal mask airway (LMA) ventilation in obese patients with airway stenosis. STUDY DESIGN: A retrospective chart review was conducted in an academic practice in a tertiary care center. METHODS: We retrospectively reviewed our experience using LMA ventilation in obese patients with airway stenosis. Lowest intraoperative O2 saturation and maximum-end tidal carbon dioxide (CO2 ) levels were recorded. Complications including intubation, unplanned admission, re-admission, postoperative pain, dysphonia, oral trauma, pneumothorax, pneumomediastinum, and tracheostomy were recorded. RESULTS: Fourteen bronchoscopies with laser incisions and dilation were performed in patients with airway stenosis exclusively using LMA ventilation. Thirteen of 14 procedures were performed on patients who had body mass index (BMI) > 30 kg/m2 . Mean BMI was noted to be 38 kg/m2 (range 25-54). All patients underwent successful laser incisions and dilation via LMA anesthesia without major or minor adverse events. The mean lowest O2 saturation level was noted to be 92%; the mean highest CO2 level was noted to be 56 mm Hg; and no patients required endotracheal intubation. CONCLUSION: In this small series of obese patients with airway stenosis, LMA anesthesia was effectively used without major or minor complications. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2582-2584, 2017.