The simultaneous use of three ventilatory techniques to maintain oxygenation in a patient undergoing tracheal laser resection of tumour.

Patients undergoing subglottic airway surgery present a challenge to both anaesthetist and surgeon, and often a balance between surgical access and method of ventilation has to be struck. We report a case in which a 38-year-old female with a large mediastinal mass causing distal tracheal obstruction underwent tracheal laser resection. In order to maintain oxygenation throughout she required simultaneous transnasal humidified rapid-insufflation ventilatory exchange, supraglottic high-frequency jet ventilation and suprastomal manual jet ventilation through her tracheostomy stoma. Where the use of one technique alone failed, the simultaneous use of all three maintained oxygenation and facilitated surgical access for the duration of the procedure.