Hunsaker Mon-Jet tube ventilation: A 15-year experience

Objective/Hypothesis: The Hunsaker Mon-Jet tube (HMJT) (Xomed, Jacksonville, FL) has been used effectively for subglottic ventilation. We previously reported a series of 552 patients over a 10-year period with no major complications. This is a continuation of that series with an additional 5 years of cases. Study Design: Retrospective consecutive case series. Methods: Patients who were ventilated with the HMJT for microlaryngeal surgery at the University of Washington Medical Center over a 15-year period (1995-2010) were identified from the Voice Disorders database. Charts were reviewed for demographic data, laryngeal diagnosis, and anesthetic parameters. Main outcome measure was the rate of complications. Results: Fifty-seven complications occurred in 49 cases out of 839 cases (5.8% complication rate). In descending order, the complications were hypoxia (SpO₂ <90%, n = 30, 3.6%), hypercarbia (end tidal CO₂ of >60 mm Hg, n = 17, 2.0%), airway obstruction (n = 4, 0.5%), barotrauma (n = 2, 0.2%), seeding of blood into trachea (n = 2, 0.2%), submucosal injection of air (n = 1, 0.1%), and mucosal damage (n = 1, 0.1%). Factors associated with complications included high body mass index (P =.04), American Society of Anesthesiology class III or IV (P =.01), history of heart disease (P =.02), history of previous laryngeal surgery (P =.02), longer duration of case (P =.006), and laser use (P =.005). Conclusions: Although subglottic ventilation via an HMJT is a safe alternative to traditional endotracheal intubation in an appropriately selected population, practitioners should remain vigilant about the known complications.