Cricotracheal Resection in a Patient with Severe Subglottic Stenosis - Advantages of a Temporary Non-Cannulated Tracheostomy

Popov, T.; Marinov, Tzvetomir; Rangachev, J.; Konov, D.; Belitova, M.

doi:10.4274/balkanmedj.2016.0108

Cited by 3 publications

(3 citation statements)

References 7 publications

(7 reference statements)

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“…4. Mean heart rate levels for groups 1, 2 and 3 at diff erent surgical time points 2.5 mm ventilated effi ciently by using laryngeal mask airway [7]. Respectively, in the present study none of the cases with laryngeal mask airway suff ered from any signifi cant complications (including desaturations) despite considerable levels of obstruction caused by the tumor masses.…”

Section: Discussionmentioning

confidence: 45%

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Marinov

Popov

Belitova

2019

Acta Medica Bulgarica

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Background and objectives: Laryngectomy with extensive extirpational neck dissection is still the treatment of choice for patients with advanced laryngeal cancer. During the initial part of laryngectomy – tracheostomy, there is a significant upper airway obstruction, caused by the cancer process itself and worsened by surgical pressure and manipulation during creation of tracheostomy. This study aims to make comparative assessment of the patient’s hemodynamic parameters, operated using three of the most popular approaches during tracheostomy: local anesthesia with preserved spontaneous ventilation; general anesthesia with ventilation by endotracheal intubation and general anesthesia with ventilation by laryngeal mask airway. Methods: A prospective cohort study was conducted in a tertiary referral center. Sixty patients with advanced laryngeal cancer appointed for total laryngectomy, were enrolled in the study. They were randomly assigned into three groups, according to the ventilation method used during the tracheostomy. Results: Patients who underwent tracheostomy under local anesthesia displayed statistically the highest levels of SAP, DAP, MAP and heart rate intraoperatively. The group of patients who underwent tracheostomy with endotracheal intubation, also displayed significantly higher levels of hemodynamic parameters during the procedure compared with the group with laryngeal mask airway ventilation, despite the fact that both groups were under general anesthesia. Conclusions: To our knowledge, this is the first study to demonstrate that laryngeal mask ventilation during tracheostomy improves intraoperative hemodynamic stability in patients undergoing total laryngectomy compared to endotracheal intubation.

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Section: Discussionmentioning

confidence: 45%

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Marinov

Popov

Belitova

2019

Acta Medica Bulgarica

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“…Computed tomography scan of the neck and chest confirmed an hourglass-shaped subglottic stenosis which carried down to the second tracheal ring. General anesthesia was induced and patient was ventilated successfully through a LMA 9,10 .…”

Section: Discussionmentioning

confidence: 99%

Ventilation through laryngeal mask in patient with severe laryngeal stenosis

Marinov

2021

International Bulletin of Otorhinolaryngology

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Introduction: Patients with an advanced airway obstruction and inspiratory stridor at rest comprise some of the most feared and complicated cases for the anesthesiologist. Case description: A 45-year-old female patient (weight 54 kg, height 166 cm), ASA III, was admitted to our hospital for tracheostomy and microlaryngeal surgery because of stenosis of the larynx. A general anesthesia was scheduled for this patient. Fentanyl 0.3 mg, propofol 200 mg and succinylcholine 100 mg were administered for anesthesia induction. After intubation 2.5% sevoflurane was used for anesthesia maintenance. Additional 0.15 mg of fentanyl was administered for pain relief. Muscle relaxation was provided with 40 mg of atracurium besilate. The operation finished successfully within 80 min. Ventilation for tracheostomy was successfully performed through flexible laryngeal mask airway (FLMA) № 3. Discussion: Patients presenting for microlaryngeal surgery frequently have a difficult airway. The chosen approach to this airway depends on the pathology and the patient's symptoms. Acceptance of the LMA as a safe practical alternative to tracheal intubation for laryngeal stenosis requires that placement be relatively facile, that position of the mask be stable throughout surgery, and that the airway be protected from the risk of aspiration. In our study during maintenance of anesthesia, there was no evidence of instability of the LMA or increased contamination of the lower respiratory tract. Conclusion:Ventilation through LMA can be safely used during tracheostomy in patients with severe laryngeal stenosis.

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“…Induction into general anesthesia and endotracheal intubation as a method for upper airway instrumentation in patients with laryngeal carcinoma is dangerous and under debate because of: expected difficult intubation due to laryngeal obstruction by the tumor, tissue trauma (can cause bleeding and/or edema), transplantation of tumor cells into lower parts of the airways causing stoma recurrence. [23][24][25][26][27][28][29][30][31] Tracheostomy can be safely performed under general anesthesia with laryngeal mask ventilation. This method for upper airway instrumentation has been recently introduced for patients with laryngeal carcinoma undergoing laryngectomies in the Department of Otorhinolaryngology at the University Hospital "Queen Giovanna" -ISUL, Sofia, Bulgaria.…”

Section: Laser Surgery Of the Larynxmentioning

confidence: 99%

Difficult airways in ENT surgery

Radichkova

Mladenov

2020

International Bulletin of Otorhinolaryngology

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Theoretical basis: Airway management for laryngeal surgery require the anesthesiologist to be adept with various methods of managing the difficult airway and performing airway exchange, to competently execute intraoperative ventilation strategies, to be proficient with inhalational and total intravenous anesthesia, and to quickly tailor anesthetic techniques to the various durations of the surgical cases.Results: When the surgical site is within or near the airway, coordination between the anesthesia and surgical teams is essential to consider the need for an ETT, which tube type to use, the oxygen enrichment plan, and mode of ventilation. The presence of laryngeal carcinoma requires precise assessment of the feasibility of endotracheal intubation. Tracheostomy can be safely performed under general anesthesia with laryngeal mask ventilation. The essential requirements for precision microlaryngeal surgery and optimal preservation of function include a clear and still surgical field, absence of patient movement, and allocation of sufficient time to carefully complete the procedure in an unhurried manner. Postoperative hemorrhage is the most serious complication of tonsillectomy. Aspiration of foreign bodies by children is a common problem around the world. Conclusion: General anesthesia in ENT surgery represents a unique example of close cooperation between the surgeon and the anesthesiologist.

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Cricotracheal Resection in a Patient with Severe Subglottic Stenosis - Advantages of a Temporary Non-Cannulated Tracheostomy

Cited by 3 publications

References 7 publications

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Ventilation through laryngeal mask in patient with severe laryngeal stenosis

Difficult airways in ENT surgery

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