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Canadian Journal of Anesthesia, Vol 27, 117-124, Copyright © 1980 by Canadian Anesthesiologists' Society

An Evaluation of the Jet Injector (Sanders) Technique for Bronchoscopy in Paediatric Patients

K. MIYASAKA 1, I. A. SLOAN 2, and A. B. FROESE 3

1 Department of Anaesthesia and Intensive Care Unit, National Children's Hospital, Tokyo, Japan
2 Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario
3 Department of Respiratory Physiology, Research Institute, Hospital for Sick Children, Toronto, Ontario

The safety and efficacy of the jet injector (Sanders) technique for bronchoscopy in children was evaluated in a lung analogue and verified by clinical trial. Although the small internal diameters of paediatric bronchoscopes accommodate lower maximum flows, they also produce higher inflation pressures than adult bronchoscopes. It was found that even the smallest tapered bronchoscope (3 mm distal diameter) can compensate for flow limitations by producing high inflation pressures and can deliver tidal volumes of 6-9 ml·kg-1 with a driving pressure of 276 kPa (40 PSI).

However, in contrast to adult bronchoscopes, the function of paediatric bronchoscopes is vulnerable to small alterations in a number of variables. For example, in addition to the size of the jet and bronchoscope, the length and angle of the jet, the shape of the bronchoscope and the introduction of a suction cannula all have a significant influence on the maximal inflation pressures and therefore the volume of ventilation that can be produced.

During diagnostic bronchoscopy of 11 patients six months-3 years of age using the jet injector technique (Sanders # 19) tidal volumes of 6-16 ml·kg-1 were achieved through 3-6 mm ID tapered bronchoscopes using driving pressures of 138-276 kPa (20-40 PSI). Effective ventilation was achieved even in non-curarized patients. This is important since most of these patients have complex airway problems and the use of a muscle relaxant may be contraindicated.

It is important to note that these results are only applicable to the jet injector technique with the Sanders # 19 adapter and any modifications to this should be carefully assessed.






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Copyright © 1980 by the Canadian Anesthesiologists' Society.