{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:32:18Z","timestamp":1790371938421,"version":"4.1.0"},"reference-count":40,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Airway management and ventilation during laryngotracheal surgery represent some of the most challenging tasks in anesthesiology. The shared airway between the surgeon and anesthesiologist requires continuous coordination to ensure optimal oxygenation while maintaining an unobstructed surgical field. Materials and Methods: This narrative review is based on a comprehensive literature search of PubMed, Embase, Scopus, and Google Scholar, covering all publications from inception to 30 June 2025. The literature search was performed using a defined Boolean strategy and explicit inclusion\/exclusion criteria, focusing on adult human subjects. The search included combinations of the terms \u201claryngotracheal surgery,\u201d \u201cairway management,\u201d \u201cventilation strategies,\u201d \u201cjet ventilation,\u201d \u201cTritube,\u201d and \u201cFlow Controlled Ventilation.\u201d Only English-language studies focused on human subjects were included. Results: Traditional ventilation strategies, such as apneic oxygenation and jet ventilation, remain widely used but present limitations in terms of gas exchange efficiency, risk of barotrauma, and surgical interference. In recent years, new devices and ventilation modes\u2014particularly the Tritube\u00ae combined with Flow-Controlled Ventilation\u2014have emerged as promising alternatives. These approaches allow continuous ventilation with minimal airway diameter, improving surgical access and patient safety. FCV\u2019s potential to optimize gas exchange and reduce mechanical power is physiologically compelling, but its supporting evidence remains limited and heterogeneous, primarily consisting of small, single-center studies and case series. Conclusions: Optimal airway and ventilation management in laryngotracheal surgery requires individualized planning, technical expertise, and close interdisciplinary communication. This approach must integrate objective neuromuscular monitoring to ensure patient safety and include a comprehensive strategy for safe postoperative airway management and extubation. While emerging technologies have significantly expanded available options, their successful application depends on training, experience, and appropriate case selection. Further high-quality clinical studies are needed to standardize protocols and validate long-term outcomes of these innovative ventilation strategies.<\/jats:p>","DOI":"10.3390\/medicina61122208","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:11:23Z","timestamp":1765793483000},"page":"2208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Current Approaches to Airway and Ventilation Strategies in Laryngotracheal Surgery: A Narrative Review"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8175-7129","authenticated-orcid":false,"given":"Roberto","family":"Giurazza","sequence":"first","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luigi de Crecchio 2, 80138 Naples, Italy"},{"name":"Department of Critical Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Corcione","sequence":"additional","affiliation":[{"name":"Department of Critical Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8684-0008","authenticated-orcid":false,"given":"Rosanna Carmela","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Critical Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Tortoriello","sequence":"additional","affiliation":[{"name":"Division of Ear, Nose and Throat Surgery, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1362-7393","authenticated-orcid":false,"given":"Francesco","family":"Coppolino","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luigi de Crecchio 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9999-3388","authenticated-orcid":false,"given":"Vincenzo","family":"Pota","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luigi de Crecchio 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Piccialli","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luigi de Crecchio 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-3586","authenticated-orcid":false,"given":"Pasquale","family":"Sansone","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luigi de Crecchio 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9659-0847","authenticated-orcid":false,"given":"Maria Beatrice","family":"Passavanti","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luigi de Crecchio 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Caterina","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luigi de Crecchio 2, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1001\/archotol.126.1.40","article-title":"Superimposed High-Frequency Jet Ventilation for Laryngeal and Tracheal Surgery","volume":"126","author":"Donner","year":"2000","journal-title":"Arch. 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