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Raiten J et al, 2012: The use of high-frequency jet ventilation for out of operating room anesthesia

Raiten J, Elkassabany N, Mandel JE
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA


Abstract

PURPOSE OF REVIEW: High-frequency jet ventilation is a novel technique for providing mechanical ventilation in the out of operating room (OOR) setting. Case reports and a small series of patients have shown it to be useful in patients undergoing cardiac arrhythmia ablations, interventional radiology procedures, and extracorporeal shock wave lithotripsy. Recently, interest in the technique has grown tremendously as the ability to provide superior surgical conditions may lead to improved efficiency and less side-effects in a variety of procedures.

RECENT FINDINGS: Atrial fibrillation ablation procedures, liver tumor ablations, and extracorporeal shock wave lithotripsy are all the procedures that benefit from minimal movement of the heart, liver, and kidney, respectively, during the procedure. Although randomized controlled trials are lacking, increasing data suggest that by maintaining the thoracic and abdominal structures relatively immobile throughout the respiratory cycle, the efficiency and safety of these procedures may be improved.

SUMMARY: Technological advances are allowing an increasing number of surgical procedures to be performed in the OOR setting. Such procedures often depend on the precise application of ablation catheters or shock waves. High-frequency jet ventilation facilitates the improved accuracy of catheter and shock wave placement, as well as efficiency of a variety of procedures. Improved efficiency, with fewer side-effects, has tremendous implications for the growth of such procedures in the OOR setting.

Curr Opin Anaesthesiol. 2012 Aug;25(4):482-5. doi: 10.1097/ACO.0b013e3283554375
PMID: 22647489 [PubMed - in process]

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Comments 1

Hans-Göran Tiselius on Tuesday, 06 March 2012 07:54

Respiratory movements during ESWL of stones in the kidney and proximal ureter are a commonly encountered problem. In the majority of patients different measures can be used to optimize the shockwave hit rate. A small group of patients might, however, have respiratory movements of a magnitude that make efficient ESWL impossible. Although most of these patients probably are better managed endoscopically, when anesthesia nevertheless is necessary, there might be occasional cases in which ESWL still is preferable. Thereby a combination of high-frequency jet ventilation and ESWL can be an alternative approach. Otherwise the great advantage of ESWL is that the whole treatment can be carried out with only analgesics and sedatives and when that is not possible, several more or less invasive methods are available.

Hans-Göran Tiselius

Respiratory movements during ESWL of stones in the kidney and proximal ureter are a commonly encountered problem. In the majority of patients different measures can be used to optimize the shockwave hit rate. A small group of patients might, however, have respiratory movements of a magnitude that make efficient ESWL impossible. Although most of these patients probably are better managed endoscopically, when anesthesia nevertheless is necessary, there might be occasional cases in which ESWL still is preferable. Thereby a combination of high-frequency jet ventilation and ESWL can be an alternative approach. Otherwise the great advantage of ESWL is that the whole treatment can be carried out with only analgesics and sedatives and when that is not possible, several more or less invasive methods are available. Hans-Göran Tiselius
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