Major complications during anaesthesia for elective laryngeal surgery in the UK: A national survey of the use of high-pressure source ventilation

Abstract

Background: Anaesthesia for laryngeal surgery may be complex and associated with complications. Methods: We conducted a national survey exploring airway management and ventilation during elective laryngeal surgery, focusing primarily on injector and jet ventilation (i.e. high-pressure source ventilation: HPSV). Results: Responses were received from 229 centres (75%). Several hospitals reported major complications during HPSV in the previous 5 yr, including three deaths. Complications during manual techniques led to seven discharge delays, three critical care admissions and three deaths. During the use of a high-frequency jet ventilation (HFJV), complications led to one discharge delay, two critical care admissions and no deaths. Complications were evenly spread between supraglottic, subglottic and transtracheal techniques. All deaths occurred in departments without HFJV. Three centres perform more than 100 transtracheal jet ventilation cases per year. None of these hospitals reported serious complications. Respondents in hospitals reporting serious complications were more likely to have plans to change practice (P=0.03). Elective laryngeal surgery is performed in 62% hospitals, of which 67% use HPSV. Supraglottic, subglottic and transtracheal techniques are used by 86, 50 and 35%, respectively. Manual ventilation devices are used widely. Only 17% of those using HPSV use an HFJV. Two-thirds of respondents initiate manual ventilation with pressures above 2 atm and only 6% start at ≤1 atm. I.V. cannulae are used for direct tracheal access by 18% and subcricoid insertion by 9%. Conclusions: HPSV may cause serious complications and there are wide variations in clinical practice. This is an area where guideline development and examination of outcome data are warranted. © The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved.