[Emergency translaryngeal ventilation with a Tuohy needle. Use in case of an inability to intubate and ventilate a curarized patient].

Intermittent translaryngeal insufflations of oxygen at high pressure by a needle could be a life-saving procedure, especially in a patient whose trachea the anesthesiologist was unable to intubate or ventilate. This study was designed to evaluate the quality of translaryngeal ventilation performed with a 16-gauge Tuohy needle and an oxygen pressure of 3 bar (300 kPa) in comparison with an usual plastic cannula of the same calibre. The studies carried out in the laboratory have shown a distinct advantage over the conventional cannula. Whereas an O2 jet delivered by a straight cannula impinged on the posterior wall of the larynx and trachea, the curved tip of the Tuohy needle deflected the axis of the O2 flow emerging from it, which then lay parallel to the longitudinal axis of the trachea. Consequently, gas flow through a simulated trachea was increased (2610 ml X s-1 vs 1240 ml X s-1), the inflation pressure being higher and the tidal volume larger. Moreover, the likelihood of injury to the posterior wall of the airway was reduced; the Tuohy needle held with a clamp close to the skin was more stable in position. Blood gases and clinical data obtained in 10 anesthetized and curarized patients without airway obstruction made it clear that translaryngeal insufflations with a 16-gauge Tuohy needle provided adequate ventilation (PaO2 values between 174 and 851 mmHg, PaCO2 between 38 and 64 mmHg). It was concluded that this technique was an efficient alternative in case of an inability to intubate a patient in apnea.