Anesthesia for Tracheobronchial Surgery

Abstract

The airway is a crucial dynamic structure that spans different anatomical zones, including the intrathoracic, extrathoracic, tracheal, bronchial, and alveolar zones. Because of its vital role as the sole oxygen-conducting pathway to the alveoli, and hence to the human body, surgery involving any portion requires careful and specific planning by both the surgeon and the anesthesiologist. The review covers essential management points for proximal and distal tracheal procedures, including a discussion of tracheal stenting and tracheoplasty.

Prebronchoplasty ventilation maneuver: Steering the outcome in the management of bronchial injuries!

“…The aforesaid maneuver falls in the bracket of “cross-field” ventilation, conventionally employed during tracheal reconstruction, particularly with defects around carina. [12] This maneuver proved to be efficacious in the evaluation of functional lung segment. With this maneuver, regular lung expansion and deflation can be achieved and therefore may provide the information of the compliance and elasticity of the collapsed lung.…”

Anesthetic Management of a Delayed Carinal Resection Following Traumatic Disruption

“…To provide OLV, we performed an oral fiberoptic intubation, as the surgical team withdrew the patient's tracheostomy tube, with a long single lumen ETT. These long single lumen tubes, produced by Fuji Systems, are 40 cm in length, wire reinforced, pliable and have a small cuff with little tubing beyond thus providing minimal bulk [15]. Under fiberoptic guidance, we directed this ETT in to the left mainstem bronchus.…”

“…We therefore considered our contingency plans. Currently, cross-field ventilation is the most common practice for carinal resections [15]. This approach has been used successfully in the acute setting with traumatic disruptions, before the onset of secondary injury such as ARDS [8].…”

“…With this approach, a sterile circuit is connected through, or distal to, the carinal injury and then passed from the operative field to the anesthesiologist. This creates a situation where both lungs can be ventilated independently [15]. However, cross-field ventilation is challenging for the surgeon during carinal surgery.…”

“…Thus, VV-ECMO provided the most stable delivery of oxygen with the best operative field. During carinal resections, it is not uncommon for the patient to require ECMO; more recent case reports have involved its use in carnal resections [15] [21] [22]. There are three types of ECMO; VV-ECMO which is used in respiratory failure, venoarterial ECMO used in cardiac failure and arteriovenous ECMO used for acute lung injury [23].…”