Simultaneous Upper Airway Dilation and Ventilation With the Trachealator: Technical Pearls and Pitfalls.

Abstract

Balloon dilation is a method for treating laryngotracheal stenosis. This traditionally necessitates temporary airway occlusion, which requires apnea, carries the risk of barotrauma, and limits the duration of dilation. The Trachealator, a non-occlusive balloon, is designed to facilitate uninterrupted ventilation during dilation. This study presents a single institution experience with the Trachealator, encompassing its applications, technical nuances, and limitations. Retrospective review identified patients who underwent non-occlusive upper airway balloon dilation (NOBD) at a tertiary laryngology center. Patient demographics, sedation type, ventilation method, intraoperative events, and clinical course were recorded. Sixteen patients (mean age = 53, 93.75% female) underwent 18 NOBD procedures under monitored anesthesia care (MAC, 72.2%) or general anesthesia (GA, 27.8%). Average NOBD duration was 1.36 min (0.5-3.0 min). Of GA procedures, 60% utilized laryngeal mask airway (LMA) while 40% underwent jet ventilation; no procedure used apneic ventilation. LMA approach required a specialized bronchial blocker adaptor. Two NOBD procedures under MAC required conversion to occlusive balloon dilation (OBD). NOBD success rate was predicated on proper anatomic placement. Temporary inadequate ventilation occurred in 1 procedure due to incomplete non-occlusive balloon inflation. No desaturation events were reported during NOBD even with > 1 min dilations. Non-occlusive balloon dilation can be a safe alternative to OBD. This study emphasizes key clinical insights regarding its use while also identifying potential challenges. This device has proven effective for upper airway dilation in three distinct settings: GA with jet ventilation, GA with LMA, and awake MAC. Each of these approaches has several unique technical aspects.