Purpose: Microlaryngeal surgery involves a delicate balance between airway control and appropriate visualization of laryngeal anatomy. When the self-centering, laser-safe Hunsaker Mon-Jet tube (Xomed, Jacksonville, FL) was introduced in 1994, to provide subglottic ventilation, the needs of both anesthesiologist and surgeon appeared to have been adequately met. However, limited data exists regarding the efficacy of this device in a large patient series. The aim of this cohort study was to explore the spectrum of patients and procedures for which this technique could be used.
Methods: We report a retrospective study of 552 patients who had undergone microlaryngeal surgery between January 1995 and June 2005, utilizing the Hunsaker Mon-Jet tube and automated jet ventilator to provide subglottic ventilation. In addition to patient demographics, overall success of ventilation and several perioperative outcomes were evaluated, including the incidence of complications.
Results: In combination with an automatic jet ventilator, the Hunsaker Mon-Jet tube was successfully utilized in more than 98% of the 552 patients, including those with severe co-morbidities, obesity and difficult airway access, providing optimal visualization of the vocal cords and excellent surgical access for a wide range of laryngeal disorders, including laser treatment. In less than 2% of patients, hypoxia, hypercarbia, or both, necessitated exchange of the Hunsaker Mon-Jet tube for a standard or laser-safe endotracheal tube with rapid resolution of the precipitating cause.
Conclusions: Subglottic ventilation via the Hunsaker Mon-Jet tube with an automated jet ventilator may be considered an effective, safe and versatile technique for the anesthetic management of microlaryngeal surgery.