FRCA Notes


Tubeless surgery


  • The presence of an endotracheal tube may impair surgical access during head and neck surgery (e.g. posterior tracheal lesion, rigid bronchoscopy )
  • Therefore tubeless anaesthesia can be attempted in order to facilitate surgery
  • Spontaneously ventilating patient

  • Ventilation via the side port of a ventilating bronchoscope
    • Intermittent ventilation ± oxygen insufflation
    • Continuous ventilation
    • Suffers from a lack of reliable measurement of end-tidal gases and the propensity for hypoxia and hypoventilation

  • Jet ventilation, be it manual low-frequency or automated high-frequency
    • Mandates use of a TIVA technique

  • Apnoeic oxygenation using THRIVE

  • Airway topicalisation using local anaesthetic in the otherwise spontaneously breathing patient
  • Volatile anaesthesia (not suitable with jet ventilation)
  • TIVA
  • Intermittent IV boluses

  • Hypoxia
  • Hypercarbia
  • Barotrauma from jet ventilation and consequent pneumo-thorax, -mediastinum or -pericardium, or subcutaneous emphysema
  • Awareness
  • Aspiration
  • Laryngospasm
  • Bronchospasm
  • Gastric distension
  • Impaired venous return ± other cardiovascular disturbances