Tracheal resection and reconstruction

Abstract

Tracheal resection and reconstructionPurpose: To review the literature on tracheal and carinal resection and reconstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The airway management is extensively reviewed. Source: Articles obtained from a Medline search (1960 to October 1997; keywords: tracheal surgery, carinal surgery, airway management). Textbook literature including the bibliographies were also consulted. Principal Findings: Benign or malignant tracheal and carinal pathology causing obstruction can be managed in several ways but resection and reconstruction are the treatment of choice for most patients with tracheal stenosis or tumour. Surgery of the trachea is a special endeavour where the airway is shared by the surgeon and the anesthesiologist. The principal anesthetic consideration is ventilation and oxygenation in the face of an open airway. Ventilation can be managed in different ways, including manual oxygen jet ventilation, high frequency jet ventilation, distal tracheal intubation, spontaneous ventilation, and cardiopulmonary bypass. Conclusion: The management of anesthesia for tracheal surgery presents many challenges to the anesthesiologist. Knowledge of the various techniques for airway management is crucial. Meticulous planning and communication between the anesthesia and surgical teams are mandatory for the safe and successful outcome of surgery for patients undergoing this procedure.Objectif: Passer en revue la documentation concernant la r&ection trach~ale et car~nale ainsi que leur reconstruction, et indiquer la conduite ~ tenir dans ce cas avec les patients, aussi bien que les directives g~n&ales pour I'administration s&uritaire de I'anesth&ie. La gestion des voies respiratoires a fait I'objet d'un examen pouss& Sources : Des articles provenant d'une recherche dans Medline (1960 ~ octobre 1997; mots-cl&: chirurgie de la trach&, chirurgie de la car~ne, gestion des voies respiratoires). Des monographies incluant les bibliographies ont aussi ~t~ consult&s. Constatations principales : La pathologie trach~ale et car~nale b~nigne ou maligne causant de I'obstruction peut &re trait~e de diff&entes mani&es, mais la r&ection et la reconstruction sont le traitement de choix pour la plupart des patients atteints de st~nose trachfiale ou de tumeur. C'est une intervention sp&iale off I'acc~s aux voies respiratoires est partag~ par le chirurgien et I'anesth&iologiste. La consideration anesth&ique principale est la ventilation et I'oxyg~nation en pr&ence de voies a&iennes ouvertes. La ventilation jet manuelle avec de I'oxyg~ne, la ventilation jet ~ haute fr~quence, rintubation trach~ale distale, la ventilation spontan& et la circulation extracorporelle sont des variantes possibles de la ventilation dans cecas. Conclusion 9 La gestion de I'anesth&ie Iors d'intervention ~. la trach& repr&ente de nombreux d~fis pour ranesth&iologiste. La connaissance des diverses techniques de gestion des voies respiratoires est pr...

Airway management for tracheal stent insertion in a patient with difficult airway

“…Stents can be a definitive treatment for patients with tracheal stenosis who are not candidates for surgery[1] or used as a palliative measure in advanced malignancy to provide symptomatic relief, as was the case in our patient. Airway management in patients with tracheal stenosis undergoing stent insertion is challenging for the anaesthesiologist who has to ensure adequate ventilation in the presence of a stenotic segment, anaesthetic depth, suppress the stress response to insertion of the bronchoscope and has to provide a relatively still and dry field during stent insertion.…”

Total Reconstruction of the Trachea: A 22-Year Follow-Up

“…Safe administration of anesthesia under such severe conditions can be regarded as an additional challenge. 13 …”

Airway Management via Laryngeal Mask in Laryngotracheal Resection

“…PITS is induced by cuff-associated submucosal compression, impaired regional blood flow, local cartilaginous ring ischemia, and secondary cicatrization 1. As most interventional procedures, including dilation2 and laser-therapy,3 almost inevitably lead to recurrence of tracheal stenosis, tracheal resection and reconstruction is generally considered the treatment of choice 12 3 In most cases, initial mechanical ventilation can be achieved either through conventional tracheal intubation or jet ventilation.…”

“…As most interventional procedures, including dilation2 and laser-therapy,3 almost inevitably lead to recurrence of tracheal stenosis, tracheal resection and reconstruction is generally considered the treatment of choice 12 3 In most cases, initial mechanical ventilation can be achieved either through conventional tracheal intubation or jet ventilation. Alternative concepts are technically demanding and require complex multidisciplinary interaction, especially between the surgeon and anesthesiologist.…”