Surgical Excision of Postintubation Granuloma Under Jet Ventilation

Abstract

Following the use of an endotracheal or tracheostomy tube, circumferential lesions, stenosis, or granulomatous lesions at the cuff level or tip of the tube may be observed on the tracheal wall. This injury mainly occurs due to excessive pressure of the cuff on the tracheal wall and may be prevented by a high-volume, low-pressure cuff and a carefully monitored tracheostomy tube. Although there is an overall improvement in the design of high-volume cuffs, hyperinflation of these cuffs may still contribute to tracheal injuries. If the size of the granuloma is limited, the lesion is treated by excision (microlaryngeal surgery) under general anaesthesia. Using jet ventilation during the operation minimizes the trauma caused by intubation and reduces the risk of oedema and the risk of barotrauma, as it provides ventilation over a possible stenosis. In addition to providing better visualization of the surgical field and superior surgeon comfort, jet ventilation also increases the success of the operation. In this case report, we aimed to present a successful anaesthesia technique performed by jet ventilation in a patient with a postintubation granuloma, which was excised by microlaryngeal surgery without the need for reintubation.