Peak Woo, MD ,Brendan Garry, MD,
Donald Perrault, Jr, MD, Stanley Shapshay, MD

Competition between the laryngologist and the anesthesiologist for the airway during laryngoscopic surgery continues to be difficult to resolve. Conventional jet ventilation has been associated with outlet obstruction, barotramna. and disturbing tissue movement. A new system of total laryngeal bypass (TLB)has been used in dogs and humans. TLB uses insertion of a custom-designed bicannular transtracheal catheter(3 mm OD, 10g) to bypass the upper airway completely during endoscopy, leaving the larynx isolated for surgery, It also provides the anesthesiologist with an adequate ventilation system without need for tracheostomy. The key to the system is a double lumen catheter that allows bidirectional flow of gases using simultaneous jetting and suction for gas exchange. This catheter can be inserted percutaneously prior to or after general anesthesia induction. Blood gas sampling in 4 dogs (17 to 32 kg) showed stable ventilation and oxygenation over 60 minutes on TLB (p02 > 200, pC02 < 45). In 5 patients with severe upper airway obstruction due to cancer or stenosis, TLB ventilation allowed the surgeon to isolate the trachea and prevent proximal soilage. TLB allows the surgeon wider access to the larynx than endotracheal tube ventilation. TLB is a promising new option in management of patients with upper airway obstruction.