The anesthesia of trachea and bronchus surgery

Abstract

The trachea and bronchus surgery is generally performed due to stenosis, traumatic injury, foreign body and tumors. Preoperative evaluation and anesthesia management are very important issues because of higher mortality and morbidity rates. Patients may be asymptomatic, but airway difficulties, hypoxia, stridor, cough, hemoptysis are common conditions in these patient population. The collaboration between the surgeon and the anesthesiologist is very substantial and necessary. Anesthetic techniques include various applications such as one lung ventilation, fiberoptic intubation, jet ventilation, and apneic oxygenation, general anesthesia with or without neuromuscular blockade. In this review, anesthesia management of the trachea and bronchus surgery is evaluated in the light of new knowledge.

Laryngeal mask for airway management in open tracheal surgery—a retrospective analysis of 54 cases

“…laryngeal mask airway may be a safe and effective alternative to tracheal intubation in open tracheal surgery. The most commonly reported airway management technique in tracheal surgery is standard orotracheal intubation using an armoured endotracheal tube (3). After opening the trachea below the stenosis, another sterile endotracheal tube is inserted into the distal segment by the surgeon (8).…”

“…Tracheal intubation with a narrow tracheal tube is the historic method of choice for airway management in this procedure (2,3). However, case reports describing other methods of airway management, including supralaryngeal jet ventilation (6) or use of supraglottic airway devices (7) have been published.…”

“…With careful patient selection, meticulous surgical and anesthetic techniques, both perioperative mortality and complication rates are considered acceptable (1). Adequate access to the lumen of trachea is required by the surgeon; simultaneously sufficient ventilation and gas exchange must be provided by the anesthesiologist (2,3). Adequate ventilation and oxygenation should be provided both in the pre-operative stenotic airway and in the intra/post-operative transected airway.…”

Tracheal perforation due to suicid attempt

“…Depending on the condition of the injury, general anesthesia conditions without single lung ventilation, fiberoptic intubation, jet ventilation, apneic respiration, and neuromuscular blockade may be required. [9] …”

Minimally invasive resection and reconstruction of the intrathoracic trachea and carina

“…Additionally, advantages of newer airway techniques have still to become evaluated in a prospective manner. The most important and well-established fact on this issue is, that an optimal collaboration and coordination between the surgeon and the anesthesiologist is essential when performing surgery of the central airways, regardless of the technique and approach that is used (20,21).…”