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Original Investigation |

Feasibility and Mortality of Airway Balloon Dilation in a Live Rabbit Model

Jiovani M. Visaya, MD1; Robert F. Ward, MD1; Vikash K. Modi, MD1
[+] Author Affiliations
1Department of Otolaryngology—Head and Neck Surgery, Weill Cornell Medical College, New York, New York
JAMA Otolaryngol Head Neck Surg. 2014;140(3):215-219. doi:10.1001/jamaoto.2013.6541.
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Importance  Endoscopic balloon dilation is commonly performed in children with airway stenosis, but guidelines are needed for selecting safe and effective balloon inflation parameters.

Objective  To determine the feasibility and safety of airway balloon dilation in live rabbits using a range of balloon diameters and pressures.

Design and Setting  Prospective animal study using 32 adult New Zealand white rabbits with 1-week follow-up performed at an academic animal research facility.

Interventions  Rabbits underwent endoscopic laryngeal balloon dilation with diameters ranging from 6 to 10 mm and pressures of 5 to 15 atm.

Main Outcomes and Measures  Rabbits were observed for intraoperative complications and postoperative morbidity.

Results  All rabbit airways were sized to a 4-0 endotracheal tube (5.4-mm outer diameter). Balloon dilation was performed safely with no intraoperative complications in 25 of 30 cases. One rabbit developed transient cyanosis during balloon inflation. Three rabbits died while undergoing dilation with 10-mm balloons, and another rabbit developed respiratory failure shortly after the procedure. All rabbits that died perioperatively lacked endoscopic evidence of airway obstruction or gross trauma. Four rabbits developed postoperative feeding difficulties that did not correlate with balloon diameter or inflation pressure.

Conclusions and Relevance  Endoscopic balloon dilation is generally well tolerated in New Zealand white rabbits. Intraoperative mortality from cardiopulmonary arrest reaches 50% when the balloon diameter exceeds the airway diameter by 4.6 mm. Postoperative feeding difficulties may occur with any balloon diameter or inflation pressure. Additional animal studies are necessary to determine the short- and long-term histologic effects of balloon dilation on the airway.

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Figure 1.
Rabbit Larynx

The airway was visualized using a Miller laryngoscope and a 0° 4-mm telescope.

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Figure 2.
Balloon Dilation

The balloon catheter was centered on the subglottis and inflated for 30 seconds.

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