High‐flow apnoeic oxygenation delivered by LMA or tracheal tube for tracheal resection and reconstruction surgery

Abstract

SummaryAirway management for tracheal resection and reconstruction can be challenging. 'LET Flow' is a novel technique using a high‐flow oxygen delivery device attached directly to a laryngeal mask or tracheal tube that may provide apnoeic oxygenation during surgery on an open trachea.We report a case where a high‐flow oxygen device, AIRVOTM 2 (Fisher & Paykel Healthcare, Aukland, New Zealand), was attached to a size three laryngeal mask airway and 100% oxygen at a flow‐rate of 40 l.min‐1 delivered across an open trachea. This permitted 42 minutes of uninterrupted surgery in an apnoeic female patient with subglottic tracheal stenosis. Oxygen saturations remained above 96% during the apnoeic period and arterial blood gas parameters within acceptable limits. To avoid possible barotrauma or volutrauma as complete tracheal closure approached, flow was reduced to 10 l.min‐1 followed by laryngeal mask cuff deflation. Mechanical ventilation recommenced at tracheal closure. 'LET Flow' provided optimal surgical conditions by removing an airway device from the operative field. No urgent interruption of surgery or rescue mechanical ventilation was required.