Airway management for endoscopic treatment of laryngotracheal stenosis

To describe the airway management techniques used during endoscopic management of laryngotracheal stenosis (LTS), and to identify patient, surgical, and clinician factors that are associated with use of jet ventilation, transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE), and intermittent apnea, including primary technique success vs failure and complications. Retrospective review of electronic medical records was performed for all patients undergoing direct laryngoscopy for LTS over a seven-year period. Patients with an existing tracheostoma at the time of surgery were excluded. Univariate chi-squared analyses were performed to identify patterns in airway management based on patient and surgical factors. A total of 92 endoscopic surgeries for 41 unique patients were identified. Airway management techniques differed based on the procedure performed ( P < 0.001). Jet ventilation and THRIVE were particularly associated with subglottic procedures, and transtracheal jet ventilation with supraglottic procedures. There were no differences in complication rate based on airway management technique. The rate of primary airway plan failure was 50 % for THRIVE, 15 % for jet ventilation, 2 % for intermittent apnea, and 0 % for endotracheal intubation ( p = 0.002). The presence of an anesthesiologist specializing in head and neck anesthesia was associated with significantly greater rates of jet ventilation and THRIVE (41 % vs 7 % for jet ventilation, 9 % vs 4 % for THRIVE; p = 0.002). Patient and surgical factors play an important role in airway management planning for patients undergoing endoscopic laryngotracheal procedures. The presence of a head and neck anesthesiologist was associated with a more diverse array of airway management options for these patients.