Jet ventilation techniques: Sanders, HFJV, and barotrauma

Meet the patient

A 64-year-old smoker with a glottic tumour arrives for laser microlaryngoscopy. The surgeon wants a tubeless, immobile field because a standard tube would obstruct the laser work. You plan total intravenous anaesthesia, a Sanders injector, and a low threshold to stop — jet ventilation, most commonly manual via a Sanders valve or automated at supraphysiologic rates, keeps the open bronchoscope clear for moving tools in and out of the airway.^[4]

The two questions that decide this case decide every jet case: can the gas get out? (the airway must be open between every pulse) and can I keep the patient asleep without a vaporiser? (TIVA standard, because gas anaesthesia leaks persistently through the open system). Hold those two questions and the whole technique slots into place — with technique choice determined by local expertise and equipment.^[4]

References5ShowHide

1. [1]Clevenger FW et al. Barotrauma associated with high-frequency jet ventilation for hypoxic salvage Arch Surg, 1990.PMID 2244805
2. [2]Frerk C et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 2015.PMID 26556848
3. [3]Cook TM et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia Br J Anaesth, 2011.PMID 21447488
4. [4]Pathak V et al. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc, 2014.PMID 24635585
5. [5]Matrka L et al. Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation. Laryngoscope, 2020.PMID 31800103