High-flow catheter ventilation during major tracheobronchial reconstruction

Techniques of Bronchial Sleeve Resection

“…The challenge for anesthesia during airway reconstruction surgery stems from simultaneously controlling the airway and maintaining satisfactory gas exchange while ensuring good surgical exposure. 24 Surgery is performed with the patient under general anesthesia. Choice of endotracheal tube is determined by the proximity of the lesion to the carina.…”

“…8 High-frequency positive pressure ventilation, or jet ventilation, through a standard endotracheal tube is a useful adjunct, particularly for sleeve resections involving the distal trachea and carina (Figure 2). 9,24-26 Cross-table ventilation is another alternative that is frequently employed for tracheal reconstruction. 27 For the bronchial and segmental airways, cross-table ventilation is not as versatile as jet ventilation but avoids the risk of barotrauma associated with inappropriate use of jet ventilation.…”

Decompressing manubriectomy under apneic oxygenation to release the median thoracic outlet compartment in bechterew disease

“…Given the anatomical modification of the neck, we were concerned with the feasibility of placing the traditional cross-field tube ventilation system 3 into the distal trachea during the opening of the trachea. Using the most recent contributions to the area of apnea oxygenation 4 and the lessons from others, 5,6 we used the physiological concept of the intrapulmonary oxygen store (eg, the preoxygenation and apneic oxygenation) for the first time in tracheal surgery. Before sectioning the airway, the patient was preoxygenated and hyperventilated with 100% oxygen only so that the 2500 to 3000 mL volume of his functional residual capacity was almost completely denitrogenated and any nitrogen entrainment ceased.…”

“…Furthermore, after the opening of the airway, a pediatric catheter was placed under visualization above the carina, and by simply delivering a small flow (10 to 15 L of oxygen per minute) under minimal breathing pressure (0 to 2 psi) to both lungs, the patient could "breathe" despite ongoing total apnea; the patient could even survive apneic periods of 50 minutes without any ill effects (P.M., personal communication). In contrast to McClish and others, 6 we do not ventilate the lungs and we use a low-pressure (0 to 2 psi) and small-flow (10 to 15 L of oxygen per minute) delivering system. This represents, in our opinion, a more physiological method of ventilation while keeping the significant advantages of the catheter technique (eg, improved surgical exposure, minimal intraoperative intrusion of the anesthetic apparatus, and facilitated reconstruction).…”

Anaesthesia consideration for carinal resection and reconstruction - A case report

“…The goal of Anaesthesia is to control the airways, maintaining satisfactory gas exchange and ensuring good surgical exposure to the trachea. 1 This can be achieved with various techniques. Cross field ventilation is commonly used technique in airway surgery especially if the defect involves the carina.…”