Background Tracheal resection and reconstruction are the most effective treatments for tracheal stenosis, but the difficulties are surgery and maintaining ventilation performed on the patient’s same airway. High-flow oxygen has begun to be applied to prolong the apnoea time in the tracheal anastomosis period for tracheal resection and reconstruction. This study aims to evaluate the effectiveness of apneic conditions with high-flow oxygen as the sole method of gas exchange during anastomosis construction. Methods A prospective study was performed on 16 patients with tracheal stenosis, with ages ranging from 19 to 70, who underwent tracheal resection and reconstruction from April 2019 to August 2020 in 108 Military Central Hospital. During the anastomosis phase using high flow oxygen of 35–40 l.min-1 delivered across the open tracheal with an endotracheal tube (ETT) at the glottis in apnoeic conditions. Results The mean (SD) apnoea time was 20.91 (2.53) mins. Mean (SD) time anastomosis was 22.9 (2.41) mins. The saturation of oxygen was stable during all procedures at 98–100%. Arterial blood gas analysis showed mean (SD) was hypercapnia and acidosis acute respiratory after 10 mins of apnoea and 20 mins apnoea respectively. However, after 15 mins of ventilation, the parameters are ultimately returned to normal. All 16 patients were extubated early and safely at the end of the operation. There were no complications, such as bleeding, hemothorax, pneumothorax, or barotrauma. Conclusion High-flow oxygen across the open tracheal under apnoeic conditions can provide a satisfactory gas exchange to allow tubeless anesthesia for tracheal resection and reconstruction.

Objective: This study aimed to evaluate the effectiveness of high‐flow oxygen as the sole method of gas exchange in apnoeic conditions during anastomosis construction. Subject and method: Between April 2019 and August 2020, 16 patients with tracheal stenosis, ages ranging from 19 to 70, underwent tracheal resection and reconstruction. Patients received total anesthesia and neuromuscular blocking agents for the duration of their surgery. During the anastomosis phase using high flow oxygen of 35 - 40 l.min‐1 delivered across an open tracheal with an endotracheal tube (ETT) at the glottis in apnoeic conditions. Result: The mean (SD) apnoea time was 20.91 ± 2.53 mins. Mean (SD) time anastomosis was 22.9 ± 2.41 mins. The saturation of oxygen was stable during all procedures at 98-100%. One patient experienced an oxygen desaturation episode to a value between 88% and 90% lasting less than 2 mins. Arterial blood gas analysis showed that there was hypercapnia and acidosis acute respiratory with pH 7.25 ± 0.04; PaCO2 67.57 ± 14.71mmHg, and PaO2 167.12 ± 76.23mmHg after 10 mins of apnoea and pH was 7.17 ± 0.05; PaCO2 79.63 ± 13.39mmHg and PaO2 186.19 ±  60.14mmHg after 20 mins apnoea, respectively. However, after 15 mins of ventilation, the parameters are ultimately returned to normal. The blood pressure and heart rate are stable at times. All 16 patients were extubated early and safely at the end of the operation. There were no complications, such as bleeding, hemothorax, pneumothorax, or barotrauma. Conclusion: High-flow oxygen across an open tracheal under apnoeic conditions can provide a satisfactory gas exchange to allow tubeless anesthesia for tracheal resection and reconstruction. The surgical field is ultimately in spacious, optimal conditions for anastomosis.

Ghép gan là phương pháp điều trị cuối cùng cho những bệnh nhân mắc bệnh lý gan giai đoạn cuối và suy gan cấp. Gây mê hồi sức cho ghép gan có nhiều thách thức như rối loạn đông máu, huyết động, toan kiềm nặng, chảy máu truyền máu khối lượng lớn, thời gian phẫu thuật dài, nhất là ở nhóm bệnh nhân suy gan cấp với điểm MELD cao. Rút ống nội khí quản ngay sau mổ cho bệnh nhân ghép gan đã được chứng minh giúp giảm biến chứng hô hấp, cải thiện tưới máu mảnh ghép, giảm ngày nằm hồi sức, giảm chi phi điều trị. Nhóm nghiên cứu đã thực hiện gây mê hồi sức cho bệnh nhân suy gan cấp điểm MELD 40 trên nền xơ gan do viêm gan B, bệnh kèm theo tăng huyết áp, đái tháo đường type 2, thông liên thất, trước mổ rối loạn đông máu nặng, lọc thay huyết tương 4 lần bilirubin toàn phần/trực tiếp 232,3/116µmol/l. Bệnh nhân được gây mê cân bằng theo đích, sử dụng thuốc mê desflurane theo đích chỉ số BIS 40 - 60, sử dụng thuốc giãn cơ rocuronium đích TOF 0, thông khí bảo vệ phổi ngay sau đặt ống nội khí quản, kiểm soát huyết động và truyền dịch theo hướng dẫn của hệ thống Volume View, điều chỉnh rối loạn đông máu theo xét nghiệm ROTEM, duy trì thân nhiệt 36 - 37oC. Sau thời gian gây mê 450 phút bệnh nhân hồi tỉnh hoàn toàn, đạt tiêu chí rút ống nội khí quản, và rút ống nội khí quản sau khi kết thúc phẫu thuật 15 phút. Bệnh nhân sau rút ống nội khí quản được theo dõi sát tại đơn vị hồi sức, không có tai biến biến chứng, ra viện sau phẫu thuật 21 ngày.

Background: Tracheal resection and reconstruction are the most effective treatment tracheal stenosis, but the difficulties are surgery and maintaining ventilation performed on the patient's same airway. High‐flow oxygen has begun to be applied prolonging the apnoea time in the tracheal anastomosis period for tracheal resection and reconstruction. This study aims to evaluate the effectiveness of apnoeic conditions with high‐flow oxygen as the sole method of gas exchange during anastomosis construction. Methods: A prospective study was performed on 16 patients with tracheal stenosis, with ages ranging from 19 to 70, underwent tracheal resection and reconstruction from April 2019 to August 2020 in 108 Military Central Hospital. During the anastomosis phase using high flow oxygen of 35-40 L/min delivered across the open tracheal with an endotracheal tube (ETT) at the glottis in apnoeic conditions. Results: The mean (SD) apnoea time was 20.91 (2.53) mins. Mean (SD) time anastomosis was 22.9 (2.41) mins. The saturation of oxygen was stable during all procedures at 98-100%. Arterial blood gas analysis showed mean (SD) was hypercapnia and acidosis acute respiratory after 10 mins of apnoea and 20 mins apnoea respectively. However, after 15 mins of ventilation, the parameters are ultimately returned to normal. All 16 patients were extubated early and safely at the end of the operation. There were no complications, such as bleeding, hemothorax, pneumothorax, or barotrauma.Conclusion: High-flow oxygen across the open tracheal under apnoeic conditions can provide a satisfactory gas exchange to allow tubeless anesthesia for tracheal resection and reconstruction.