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Schieren M, Stoelben E. [Anesthesia and Surgery of the Trachea]. Zentralbl Chir 2024; 149:260-267. [PMID: 38122803 DOI: 10.1055/a-2222-7797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
This article aims to review the current anaesthetic management of tracheal resections.Apart from the "traditional" approach of induction of general anaesthesia with conventional tracheal intubation and cross-field intubation or jet ventilation during the resection phase, there has lately been a trend towards less invasive techniques.Regional anaesthesia, laryngeal mask airways and preservation of spontaneous ventilation are among the new anaesthetic approaches. Current data suggest potential advantages compared with conventional tracheal intubation.Extracorporeal membrane oxygenation may provide adequate gas exchange and/or cardiovascular support for complex resections and reconstructions. In addition, it may serve as a reliable "backup" technique, in case of oxygenation difficulties with the use of other devices.Given the vast spectrum of different anaesthetic approaches to tracheal surgery, interdisciplinary planning is essential to identify the optimal technique on a case-by-case basis. During that process, the localisation and consistency of the airway lesion, comorbidities and the functional status of the respiratory system and specific surgical approach need to be taken into account.As there is a lack of high-quality data, evidence-based comparisons of different anaesthetic techniques are not possible.
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Affiliation(s)
- Marc Schieren
- Klinik für Anästhesiologie und operative Intensivmedizin, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Erich Stoelben
- Thoraxklinik Köln, St. Hildegardis Krankenhaus, Köln, Deutschland
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2
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Schulte SC, Fischer S. [Management of Tracheobronchial Stenoses]. Zentralbl Chir 2023; 148:293-303. [PMID: 37267982 DOI: 10.1055/a-1809-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tracheobronchial stenoses consist of a spectrum of conditions that may result in focal or diffuse narrowing of the trachea or downstream bronchial system. The purpose of this paper is to provide an overview of the most commonly encountered conditions in terms of diagnosis and therapeutic options as well as the associated challenges for practitioners.
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Liu Y, Liang L, Yang H. Airway management in "tubeless" spontaneous-ventilation video-assisted thoracoscopic tracheal surgery: a retrospective observational case series study. J Cardiothorac Surg 2023; 18:59. [PMID: 36737801 PMCID: PMC9898933 DOI: 10.1186/s13019-023-02157-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgeon and anesthetist share the airway in a simpler way in the resection and reconstruction phase of tracheal surgery in tubeless spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS). Tubeless SV-VATS means stable spontaneous ventilation in the resection and reconstruction phase to anesthesiologist, and unobstructed surgical field to surgeon. What's the ideal airway management strategy during "Visual Field tubeless" SV-VATS for tracheal surgery is still an open question in the field. METHODS We retrospectively reviewed 33 patients without sleeve and carina resections during the study period (2018-2020) in our hospital. The initial management strategy for these patients was spontaneous ventilation for intrathoracic tracheal resection and reconstruction. We obtained and reviewed medical records from our institution's clinical medical records system to evaluate the airway management strategy and device failure rate for tracheal resection in Tubeless SV-VATS. RESULTS Between 2018 and 2020, SV-VATS was first attempted in the 33 patients who had intrathoracic tracheal surgery but without sleeve and carina resections. All patients underwent bronchoscopy (33/33) and 8 patients (8/33) received partial resection before surgery. During the surgery, the airway device comprised either a ProSeal laryngeal mask airway (ProSeal LMA) (n = 27) or single lumen endotracheal tube (n = 6). During the resection and reconstruction phase, Visual Field tubeless SV-VATS failed in 9 patients, and breathing support switched to plan B which is traditional ventilation of a single lumen endotracheal tube for cross field intubation (n = 4) and ProSeal LMA alongside a high-frequency catheter (high-frequency jet ventilation, HFJV) (n = 5) into the distal trachea ventilation. Preoperative respiratory failure or other ventilation-related complications were not observed in this cohort. CONCLUSION Base on current analysis either ProSeal LMA or endotracheal tube is an effective airway management strategy for tubeless SV-VATS with appropriate patient selection. It also provides breathing support conversion option when there's inadequate ventilation.
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Affiliation(s)
- Yuying Liu
- grid.470124.4Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120 China
| | - Lixia Liang
- grid.470124.4Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120 China
| | - Hanyu Yang
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Rd, Guangzhou, 510120, China.
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He B, Zhang S, Ren L, Zhou Y, Chen Q, Tang J, Zhang Y, Tang M, Qiu Y, Wang H. Case report: Thyroid carcinoma invading trachea: Multidisciplinary resection and reconstruction assisted by extracorporeal membrane oxygenation. Front Oncol 2023; 12:990600. [PMID: 36713510 PMCID: PMC9878384 DOI: 10.3389/fonc.2022.990600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Background When thyroid cancer invades the trachea, tumor resection and trachea reconstruction are required. Although the traditional way of anesthesia and tracheal intubation can maintain the necessary ventilation function during the operation, tracheal intubation affects the surgical field of vision and is not conducive to the protection of the recurrent laryngeal nerve beside the trachea during the operation. Case presentation Extracorporeal membrane oxygenation (ECMO) is used to replace traditional tracheal intubation in the process of resection and end-to-end anastomosis of tracheal tumors, and complete tracheal tumor resection and trachea reconstruction are achieved. Conclusion Using ECMO for thyroid carcinoma resection, invaded trachea resection, and trachea reconstruction is safe and effective, which reduces the obstruction of endotracheal intubation on the operative field, guarantees the rapid and efficient end-to-end anastomosis in the upper trachea, and clearly avoids laryngeal recurrent nerve injury in the process of anastomosis.
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Affiliation(s)
- Bo He
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shixin Zhang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lin Ren
- Department of Breast and Thyroid Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi Zhou
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qiao Chen
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinghua Tang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Meng Tang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China,*Correspondence: Meng Tang, ; Yang Qiu, ; Haidong Wang,
| | - Yang Qiu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China,*Correspondence: Meng Tang, ; Yang Qiu, ; Haidong Wang,
| | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China,*Correspondence: Meng Tang, ; Yang Qiu, ; Haidong Wang,
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Muacevic A, Adler JR, P SR, MS B, Nanjunda Rao RB. Achieving Successful Extubation and Cost-Effective Recovery Following Anesthetic Airway Management in Supracarinal Tracheal Reconstruction Surgeries: A Retrospective Analysis. Cureus 2023; 15:e34225. [PMID: 36852367 PMCID: PMC9960377 DOI: 10.7759/cureus.34225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction From an anesthesiologist's perspective, perioperative concerns related to supracarinal tracheal reconstruction surgery include having uninterrupted smooth ventilation without any laryngeal edema, glottic dysfunction, and airway leak. Surgical concerns comprise various kinds of anastomotic dissections, fistulas to innominate arteries, and the esophagus. The most serious complication following tracheal surgery is anastomotic separation, which might manifest modestly as stridor, respiratory distress, and extremis. To avoid dire repercussions, prompt management and securing the airway are necessary. Against this background, we wanted to highlight the importance of early extubation and discharge of supracarinal tracheal reconstruction patients from hospitals without any postoperative complications and with the least expenses possible, since most of these patients have already undergone postintubation tracheal stenosis and prolonged intensive care unit stay, and have experienced significant financial burden incurring from preceding events. Methodology Medical records of all patients admitted for tracheal reconstruction during the period from March 2019 to April 2022 (four years) were reviewed to collect patient demographic details, surgical descriptions, anesthesia data, records of pre-anesthetic evaluations, and postoperative details up until the hospital discharge. Results The most common reason for tracheal stenosis among our patients was post-intubation tracheal stenosis (PITS), which was seen in 8/13 patients (61.53%); 4/13 patients (30.76%) had stridor at rest and underwent emergency tracheostomy preoperatively immediately following admission to the hospital. The stenosis was situated at a median distance of 3 cm [interquartile range (IQR): 0.5-7] from the true vocal cords or 7 cm (IQR: 3-9) from the carina. The median length of tracheal resection was 2 cm (IQR: 1-4). We observed that the mode of induction for airway management was tracheostomy tube in four patients (with 90% tracheal stenosis), placement of laryngeal mask airway (LMA) with spontaneous ventilation in four patients (with 75% tracheal stenosis), and small-size (#5-7.5 sizes) endotracheal tube (ETT) placement in five patients (with less than 75% tracheal stenosis). The postoperative complication noted was bleeding from the operative site in 1/13 patients (7.6%); a 0% mortality rate was noted during the hospital stay and up until six months post-discharge. We noted that the median duration of postoperative hospitalization was five days (IQR: 2-15), and the total cost incurred by each patient was less than INR 85,000 (USD 1,000). Conclusion Our analysis revealed that all our patients were extubated in the operative room and shifted to the ward. In the "open airway phase", standard distal tracheal intubation and cross-field ventilation techniques, and tracheal suturing were facilitated by the apnoea-ventilation-apnoea technique. Both the techniques along with the emergency tracheostomies done in severe tracheal obstruction preoperatively and intraoperative anesthesia management with the insertion of LMA Supreme, maintained with spontaneous breathing techniques, offered potential advantages in the management of supracarinal tracheal reconstruction surgeries. The multidisciplinary teamwork along with close communication and good rapport with the surgical team was found to be the key factor in the fast-track extubation and recovery of these patients.
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Szentgyorgyi L. Airway Management for Tracheal Resections - Comments on a Controversial Approach. J Cardiothorac Vasc Anesth 2023; 37:193. [PMID: 36307351 DOI: 10.1053/j.jvca.2022.09.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Lajos Szentgyorgyi
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Cardiothoracic Critical Care Unit, Manchester, United Kingdom.
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7
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Defosse J, Schieren M, Hartmann B, Egyed E, Koryllos A, Stoelben E, Wappler F, Böhmer A. A New Approach in Airway Management for Tracheal Resection and Anastomosis: A Single-Center Prospective Study. J Cardiothorac Vasc Anesth 2022; 36:3817-3823. [PMID: 35798632 DOI: 10.1053/j.jvca.2022.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The evaluation of the use of laryngeal mask airways (LMA) as an alternative form of airway management for surgical tracheal reconstruction. DESIGN A prospective case series. SETTING At a single German university hospital. PARTICIPANTS Ten patients. INTERVENTIONS The use of LMA for airway management in surgical reconstruction of the trachea. MEASUREMENTS AND MAIN RESULTS Ten patients with tracheal stenosis of 50% to 90% were enrolled prospectively during the study period. The airway management consisted of the insertion of an LMA. During resection and reconstruction, high-frequency jet ventilation was used. Several arterial blood gas analyses (ABG) were performed before, during, and after the tracheal resection and reconstruction. All values were presented as median and interquartile ranges or as absolute and relative values, and no emergency change to cross-field intubation was necessary. The lowest PaO2 was 93 mmHg in 1 patient after 20 minutes of jet ventilation, whereas PaO2 increased after the induction phase and remained stable in 9 patients. There were no intraoperative complications related to anesthetic management apart from transient hypercarbia during and after jet ventilation. Preoperative and postoperative ABG were comparable. One patient required immediate postoperative ventilatory support. Two patients developed postoperative pneumonia, leading to their admission to the intensive care unit. One patient was operated with a palliative approach due to massive dyspnea and died in the next postoperative course. CONCLUSIONS The use of LMA is an alternative option in airway management for tracheal reconstruction, even in patients with significant tracheal stenosis. Potential advantages compared to tracheal intubation are unimpaired access to the operative field and the lack of stress on the fresh anastomosis.
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Affiliation(s)
- Jerome Defosse
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany.
| | - Mark Schieren
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Burkhard Hartmann
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Enikö Egyed
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Aris Koryllos
- Witten/Herdecke University, Medical Center Cologne-Merheim, Lung Clinic, Thoracic Surgery, Cologne, Germany
| | - Erich Stoelben
- Witten/Herdecke University, Medical Center Cologne-Merheim, Lung Clinic, Thoracic Surgery, Cologne, Germany
| | - Frank Wappler
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Andreas Böhmer
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
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8
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Kuut MH, Honings J, Marres HAM, Mourisse JMJ, Verhagen AFTM. Controlled mechanical ventilation through a narrow bore lumen during tracheal surgery: A prospective observational study. Eur J Anaesthesiol 2022; 39:835-837. [PMID: 35875915 DOI: 10.1097/eja.0000000000001717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marieke H Kuut
- From the Department of Anesthesia, Pain and Palliative Medicine (MHK, JMJM), the Department of Oto-Rhino-Laryngology and Head and Neck Surgery (JH, HAMM), and the Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands (AFTMV)
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Choi SR, Eom DW, Lee TY, Jung JW, Lee GH, Lee SC, Park SY, Kim TH. Anesthetic Management of Upper Tracheal Cancer Resection and Reconstruction: A Case Report. Int Med Case Rep J 2022; 15:443-447. [PMID: 36046034 PMCID: PMC9423117 DOI: 10.2147/imcrj.s376721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022] Open
Abstract
Tracheal tumor resection and reconstruction is the primary treatment for tracheal tumors. The trachea is the surgical site as well as an important channel to ensure ventilation and maintain oxygenation during surgery. In this report, we describe the successful management of an upper tracheal tumor in a 50-year-old patient. The tumor was situated approximately 2–3 cm below the vocal cords, occluding the tracheal lumen by 80%. Conventional orotracheal intubation was expected to be impossible, and the patient was managed with an I-Gel supraglottic airway for mechanical ventilation with the assistance of venovenous extracorporeal membrane oxygenation (VV ECMO). After securing tracheal intubation via the tracheostomy site, VV ECMO was weaned off, and mechanical ventilation was changed to tracheal intubation. Eventually, tracheal tumor resection and reconstruction were successfully performed under general anesthesia. No specific events occurred during anesthetic management. Careful preoperative planning and good teamwork made the procedure possible without complications.
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Affiliation(s)
- So Ron Choi
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Deuk Won Eom
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Tae Young Lee
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Ji Wook Jung
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Gang Hyun Lee
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
- Correspondence: Sang Yoong Park, Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea, Tel +82-51-240-5390, Fax +82-51-247-7819, Email
| | - Tae Hyung Kim
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
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Segura-Salguero JC, Díaz-Bohada L, Ruiz ÁJ. Perioperative management of patients undergoing tracheal resection and reconstruction: a retrospective observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2022; 72:331-337. [PMID: 35183604 PMCID: PMC9373245 DOI: 10.1016/j.bjane.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/16/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lorena Díaz-Bohada
- Hospital Universitario San Ignacio, Department of Anesthesiology, Bogotá, Colombia
| | - Álvaro J Ruiz
- Pontificia Universidad Javeriana, Department of Internal Medicine, Bogotá, Colombia
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11
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Schieren M, Wappler F, Defosse J. Anesthesia for tracheal and carinal resection and reconstruction. Curr Opin Anaesthesiol 2022; 35:75-81. [PMID: 34873075 DOI: 10.1097/aco.0000000000001082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of current anesthetic management of tracheal and carinal resection and reconstruction. RECENT FINDINGS In addition to the traditional anesthetic approach using conventional tracheal intubation after induction of general anesthesia and cross-field intubation or jet-ventilation once the airway has been surgically opened, there is a trend toward less invasive anesthetic procedures. Regional anesthetic techniques and approaches focusing on the maintenance of spontaneous respiration have emerged. Especially for cervical tracheal stenosis, laryngeal mask airways appear to be an advantageous alternative to tracheal intubation.Extracorporeal support can ensure adequate gas exchange and/or perfusion during complex resections and reconstructions without interference of airway devices with the operative field. It also serves as an effective rescue technique in case other approaches fail. SUMMARY The spectrum of available anesthetic techniques for major airway surgery is immense. To find the safest approach for the individual patient, comprehensive interdisciplinary planning is essential. The location and anatomic consistency of the stenosis, comorbidities, the functional status of respiratory system, as well as the planned reconstructive technique need to be considered. Until more data is available, however, a reliable evidence-based comparison of different approaches is not possible.
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Affiliation(s)
- Mark Schieren
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
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12
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Marwaha A, Kumar A, Sharma S, Sood J. Anaesthesia for tracheal resection and anastomosis. J Anaesthesiol Clin Pharmacol 2022; 38:48-57. [PMID: 35706632 PMCID: PMC9191789 DOI: 10.4103/joacp.joacp_611_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/28/2021] [Accepted: 03/07/2021] [Indexed: 11/05/2022] Open
Abstract
Tracheal resection anastomosis is one of the most challenging surgeries. Notable advances in this field have made possible a variety of surgical, anesthetic, and airway management options. There are reports of newer approaches ranging from use of supraglottic airway devices, regional anesthesia, and extracorporeal support. Endotracheal intubation with cross-field ventilation and jet ventilation are the standard techniques for airway management followed. These call for multidisciplinary preoperative planning and close communication during surgery and recovery. This review highlights the anesthetic challenges faced during tracheal resection and anastomosis with specific considerations to preoperative workup, classification of tracheal stenosis, airway management, ventilation strategies, and extubation. The newer advances proposed have been reviewed.
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13
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Gao R, Gu X, Zhang S, Ma S, Xu L, Li M, Gu L. Intraoperative airway management for patients with tracheal tumors: A case series of 37 patients. Thorac Cancer 2021; 12:3046-3052. [PMID: 34626082 PMCID: PMC8590894 DOI: 10.1111/1759-7714.14181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tracheal tumors are rare. The aim of this case series was to investigate airway selection during radical surgery for patients with tracheal tumors. METHODS Here, we performed a retrospective case review of patients with tracheal tumors who underwent tracheal surgery in our center. A total of 37 cases, including 26 patients with primary tracheal tumors and 11 cases with advanced thyroid cancer, were enrolled into the study. Baseline characteristics and differential prognosis of included patients were estimated. We summarize the strategies for intraoperative airway selection and analyze the risk factors associated with delayed extubation. RESULTS There is a trend for primary tracheal tumors to appear toward the upper (9 of 26) and middle third (9 of 26) of the trachea, followed by the lower third airway (8 of 26). Advanced thyroid cancers occur most frequently in the upper trachea (7 of 11) and then the middle trachea (4 of 11). All primary and secondary patients underwent R0 resection. Minor histological subtypes were found to correlate with a poor prognosis. Extracorporeal support and tracheotomy intubation were applied in high-risk cases, and a total of 32 patients achieved intrathoracic intubation during the surgical process. Intensive care unit (ICU) delay (>1 day) was observed among 25 patients, which were not enriched in cases who underwent cross-field endotracheal intubation. Additionally, temporal suboptimal oxygenation (SpO2 < 95%) was an independent risk factor of ICU delay. CONCLUSIONS Airway selection plays an important role in successful tracheal surgery, and an appropriate ventilation routine depends on the patient and a surgical process which is safe and effective.
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Affiliation(s)
- Rong Gao
- Department of Anesthesiology, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Xiaolan Gu
- Department of Anesthesiology, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Shuai Zhang
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Shuliang Ma
- Department of Anesthesiology, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Ming Li
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Lianbing Gu
- Department of Anesthesiology, Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
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14
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Evans MA, Stephens EH, Lavin JM, Chun Y, Maurrasse S, Backer CL. Use of a Rigid Bronchoscope as the Sole Prebypass Airway During Pediatric Tracheal Tumor Resection: A Case Report. A A Pract 2021; 15:e01399. [PMID: 33784445 DOI: 10.1213/xaa.0000000000001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe the anesthetic and operative techniques utilized for a tracheal tumor resection in a pediatric patient with 95% tracheal occlusion. In prior tracheal tumor cases that dictated complete resection, our team had been able to comfortably bypass a tumor with an endotracheal tube. In this case, we could not intubate past the tumor. A rigid bronchoscope was able to be placed past the tumor, so we continued with sternotomy and dissection before cardiopulmonary bypass while ventilating through that bronchoscope as our definitive airway.
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Affiliation(s)
- Michael A Evans
- From the Department of Anesthesiology, Northwestern Feinberg School of Medicine, Chicago, Illinois.,Division of Cardiac Anesthesia, Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Jennifer M Lavin
- Department of Otolaryngology - Head & Neck Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois.,Division of Otorhinolaryngology-Head & Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Yeona Chun
- From the Department of Anesthesiology, Northwestern Feinberg School of Medicine, Chicago, Illinois.,Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sarah Maurrasse
- Department of Otolaryngology - Head & Neck Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois.,Division of Otorhinolaryngology-Head & Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Carl L Backer
- Department of Cardiothoracic Surgery, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Kentucky
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Pořízka M, Michálek P, Votruba J, Abdelmalak BB. Extracorporeal Oxygenation Techniques in Adult Critical Airway Obstruction: A Review. Prague Med Rep 2021; 122:61-72. [PMID: 34137682 DOI: 10.14712/23362936.2021.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Extracorporeal life support has been increasingly utilized in different clinical settings to manage either critical respiratory or heart failure. Complex airway surgery with significant or even total perioperative airway obstruction represents an indication for this technique to prevent/overcome a critical period of severe hypoxaemia, hypoventilation, and/or apnea. This review summarizes the current published scientific evidence on the utility of extracorporeal respiratory support in airway obstruction associated with hypoxaemia, describes the available methods, their clinical indications, and possible limitations. Extracorporeal membrane oxygenation using veno-arterial or veno-venous mode is most commonly employed in such scenarios caused by endoluminal, external, or combined obstruction of the trachea and main bronchi.
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Affiliation(s)
- Michal Pořízka
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Pavel Michálek
- Department of Anaesthesia, Antrim Area Hospital, Antrim, United Kingdom.,Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiří Votruba
- 1st Department of Tuberculosis and Respiratory Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Basem B Abdelmalak
- Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA
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16
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Menna C, Fiorelli S, Massullo D, Ibrahim M, Rocco M, Rendina EA. Laryngeal mask versus endotracheal tube for airway management in tracheal surgery: a case-control matching analysis and review of the current literature. Interact Cardiovasc Thorac Surg 2021; 33:426-433. [PMID: 33956960 DOI: 10.1093/icvts/ivab092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The endotracheal tube (ETT) and the laryngeal mask airway (LMA) are possible strategies for airway management during tracheal resection and reconstruction for tracheal and laryngotracheal stenosis. The goal of the study was to analyse and compare outcomes in the LMA and ETT groups. METHODS Between 2003 and 2020, a total of 184 patients affected by postintubation, post-tracheostomy and idiopathic stenosis who had tracheal or laryngotracheal resections and reconstructions via a cervicotomy were retrospectively enrolled in this single-centre study. In 29 patients, airway management was achieved through LMA during tracheal surgery, whereas in 155 patients, it was achieved through ETT. A case-control matching analysis was performed with a 1:1 ratio, according to age, gender, body mass index, aetiology and length of stenosis (1-4 cm), resulting in 22 patients managed through LMA (LMA group) matched with 22 patients managed through ETT (ETT group). RESULTS No significant differences were found in the reintubation rate, 30-day mortality and postoperative length of stay. Operative time was shorter in patients with LMA (96.23 ± 34.72 min in the ETT group vs 76.14 ± 26.94 min in the LMA group; P = 0.043). Intensive care unit (ICU) admission rate and stay were lower in the LMA group [18 in the ETT group vs 8 in the LMA group, odds ratio = 10.17, confidence interval (CI) 95% 1.79-57.79; P = 0. 009; 22.77 ± 16.68 h in ETT group vs 9.23 ± 13.51 h in LMA group; P = 0.005]. Dysphonia was more frequent in the ETT group than in the LMA group (20 in the ETT group vs 11 in the LMA group, odds ratio = 13.79, CI 95% 1.86-102; P = 0.010). CONCLUSIONS LMA is a feasible option for airway management in tracheal surgery, with lower operative time, ICU admission rate, ICU length of stay and postoperative dysphonia occurrence.
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Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Silvia Fiorelli
- Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
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17
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Yue L, Zhang R, Duan G. The Relationship Between Smoking and COVID-19 Progression. Nicotine Tob Res 2021; 23:880-881. [PMID: 33244593 PMCID: PMC7717401 DOI: 10.1093/ntr/ntaa245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Limin Yue
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China.,Department of Epidemiology, College of Public Health, Hainan Medical University, Haikou, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
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18
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Li JJ, Li N, Ma WJ, Bao MX, Chen ZY, Ding ZN. Safety application of muscle relaxants and the traditional low-frequency ventilation during the flexible or rigid bronchoscopy in patients with central airway obstruction: a retrospective observational study. BMC Anesthesiol 2021; 21:106. [PMID: 33823804 PMCID: PMC8022393 DOI: 10.1186/s12871-021-01321-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Bronchoscopy treatments of central airway obstruction (CAO) under general anesthesia are high-risky procedures, and posing a giant challenge to the anesthesiologists. We summarized and analyzed our clinical experience in patients with CAO undergoing flexible or rigid bronchoscopy, to estimate the safety of skeletal muscle relaxants application and the traditional Low-frequency ventilation. Methods Clinical data of 375 patients with CAO who underwent urgent endoscopic treatments in general anesthesia from January 2016 to October 2019 were retrospectively reviewed. The use ratio of skeletal muscle relaxants, dose of skeletal muscle relaxants used, the incidence of perioperative adverse events, adequacy of ventilation and gas exchange, post-operative recovery between rigid bronchoscopy and flexible bronchoscopy therapy, and risk factors for postoperative ICU admission were evaluated. Results Of the 375 patients with CAO, 204 patients were treated with flexible bronchoscopy and 171 patients were treated with rigid bronchoscopy. Muscle relaxants were used in 362 of 375 patients (including 313 cisatracurium, 45 rocuronium, 4 atracurium, and 13 unrecorded). The usage rate of muscle relaxants (96.5% in total) was very high in patients with CAO who underwent either flexible bronchoscopy (96.6%) or rigid bronchoscopy (96.5%) therapy. The dosage of skeletal muscle relaxants (Cisatracium) used was higher in rigid bronchoscopy compared with flexible bronchoscopy therapy (10.8 ± 3.8 VS 11.6 ± 3.6 mg, respectively, p < 0.05). No patient suffered the failure of ventilation, bronchospasm and intraoperative cough either in flexible or rigid bronchoscopy therapy. Hypoxemia was occurred in 13 patients (8 in flexible, 5 in rigid bronchoscopy) during the procedure, and reintubation after extubation happened in 2 patients with flexible bronchoscopy. Sufficient ventilation was successfully established using the traditional Low-frequency ventilation with no significant carbon dioxide accumulation and hypoxemia occurred both in flexible and rigid bronchoscopy group (p > 0.05). Three patients (1 in flexible and 2 in rigid) died, during the post-operative recovery, and the higher grade of American Society of Anesthesiologists (ASA) and obvious dyspnea or orthopnea were the independent risk factors for postoperative ICU admission. Conclusion The muscle relaxants and low-frequency traditional ventilation can be safely used both in flexible and rigid bronchoscopy treatments in patients with CAO. These results may provide strong clinical evidence for optimizing the anesthesia management of bronchoscopy for these patients.
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Affiliation(s)
- Jing-Jin Li
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Nan Li
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Wei-Jia Ma
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Ming-Xue Bao
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Zi-Yang Chen
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Zheng-Nian Ding
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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19
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Fiorelli S, Saltelli G, Teodonio L, Massullo D. Airway management by i-gel for open tracheal resection and reconstruction via combined cervicotomy and sternotomy surgical approach: A case report. Ann Card Anaesth 2021; 24:260-262. [PMID: 33884991 PMCID: PMC8253010 DOI: 10.4103/aca.aca_59_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Surgical resection and tracheal reconstruction are the most effective treatment options for airway stenosis. Tracheal surgery is challenging and requires a multidisciplinary approach and a highly specialized team of anesthesiologists and thoracic surgeons that are "sharing the airways". Several airway management tools, different devices, and various approaches can be required to ensure ventilation and gas exchange. We describe the case of a patient affected by tight tracheal stenosis, submitted to tracheal resection and reconstruction via combined cervicotomy and sternotomy surgical approach. Airway management was successfully performed by i-gel® (Intersurgical, UK) supraglottic device.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
| | - Giorgia Saltelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
| | - Leonardo Teodonio
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
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20
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Smeltz AM, Bhatia M, Arora H, Long J, Kumar PA. Anesthesia for Resection and Reconstruction of the Trachea and Carina. J Cardiothorac Vasc Anesth 2020; 34:1902-1913. [DOI: 10.1053/j.jvca.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022]
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Abstract
PURPOSE OF REVIEW Anesthesia for the resection and reconstruction of the tracheobronchial tree for neoplastic disease is challenging, both from surgical as well as anesthetic points of view. There are no published recommendations or guidelines addressing anesthetic and airway management dilemmas that arise during these surgical interventions. This review presents key aspects of preoperative imaging evaluation, surgical planning, as well as anesthesia and airway management during these complex cases. RECENT FINDINGS Newly published articles highlight both the surgical and anesthetic challenges encountered during tracheobronchial resections and emphasize the importance of creating specialized, high-volume centers for good patient outcomes. Of great importance is the development of a preoperative joint anesthetic-surgical plan which includes a patient-specific airway management strategy. This review presents newer and less commonly employed anesthetic management strategies which have been recently described in the literature to allow expansion of care to patients who were previously deemed too high risk for surgery. SUMMARY With advances in technology, the use of classical ventilation methods in conjunction with newer alternatives, such as extracorporeal membrane oxygenation, creates the premise for a more individualized, safer and controlled approach to tracheobronchial resections for oncologic purposes.
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22
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Abstract
Nonintubated anesthesia is feasible and might be associated with shorter surgery time and shorter hospitalization for tracheal/carinal resection and reconstruction. Only case reports and a few small retrospective series study were conducted to evaluate nonintubated anesthesia for tracheal/carinal resection and reconstruction; no randomized control trials exist. Further exploration should focus on selection of optimal candidates and prospective validation.
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23
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Kwanten LE, Madhivathanan P. Supraglottic airway devices: current and future uses. Br J Hosp Med (Lond) 2019; 79:31-35. [PMID: 29315046 DOI: 10.12968/hmed.2018.79.1.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Supraglottic airway devices have increasingly been used in anaesthesia since their invention in 1982. Now over half of general anaesthetic cases in the UK use them, and they have vital roles in difficult airway algorithms, pre-hospital use and emergency medicine. This article presents the current evidence regarding the complications of these devices, and compares these devices and endotracheal intubation. The technology of the newer generation devices has improved the safety profile, and they may be considered a better choice than endotracheal tubes in some cases. There may be a case for using these devices in a wider range of surgical and non-surgical cases.
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Affiliation(s)
- Lloyd E Kwanten
- Locum Consultant in Cardiothoracic Anaesthesia, Department of Perioperative Medicine, Barts Health NHS Trust, London EC1A 7BE
| | - Pradeep Madhivathanan
- Consultant in Cardiothoracic Anaesthesia and Critical Care Medicine, Department of Critical Care, Papworth Hospital NHS Foundation Trust, Cambridge
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24
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Aleksanyan A, Stoelben E. [Laryngo-Tracheal Resection as an Alternative to Permanent Tracheostomy]. Pneumologie 2019; 73:211-218. [PMID: 30703818 DOI: 10.1055/a-0809-0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cervical stenosis of the trachea caused by tracheotomy, tumor or without defined reason (idiopathic) can be treated by resection and anastomosis with good early and long-term results. Involvement of the ring cartilage makes the procedure technically demanding and increases the risk of morbidity. We describe our technique of laryngotracheal resection and reconstruction and compare the perioperative results with standard tracheal resection. PATIENTS AND METHODS Between January 2005 and December 2015, we performed about 800 procedures on the trachea including 76 standard cervical tracheal resections and 35 laryngotracheal resection. Resections were carried out with direct anastomosis without intraoperative tracheotomy or intralaryngeal stenting. Patient records were retrospectively analysed for perioperative data. RESULTS The main cause of stenosis or defect of the trachea and operation was preceding tracheotomy. Idiopathic stenosis, tumors and subglottic stenosis in Wegener disease were less common. There were no disturbances of healing of the anastomosis in any patient. Tracheotomy in the course of treatment for intralaryngeal swelling or recurrent nerve palsy was necessary in 3 (standard) and 2 (laryngotracheal) patients. Postoperative tracheostomy was closed in all patients within 3 months. Pulmonary complications and recurrent nerve palsy occurred in 5/4 and 2/2 of the patients without significant differences between the 2 groups. One patient died in each group from pulmonary complications. CONCLUSION The laryngotracheal resection is a relevant part of cervical tracheal surgery. It can be performed without significantly higher morbidity and can restore lung function and quality of voice.
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Affiliation(s)
- A Aleksanyan
- Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, private Universität Witten/Herdecke, Köln
| | - E Stoelben
- Lungenklinik Köln-Merheim, Lehrstuhl für Thoraxchirurgie, Kliniken der Stadt Köln gGmbH, private Universität Witten/Herdecke, Köln
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25
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Affiliation(s)
- Hovig V Chitilian
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Xiadong Bao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Paul H Alfille
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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26
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Egan M, Redmond KC. High‐flow apnoeic oxygenation delivered by LMA or tracheal tube for tracheal resection and reconstruction surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.21466/ac.haodblo.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Michael Egan
- Consultant, AnaesthesiaBeacon HospitalDublinIreland
| | - Karen C. Redmond
- ConsultantThoracic and Lung Transplant Surgery, Mater Misericordiae Universty Hospital and Beacon HospitalDublinIreland
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Schieren M, Egyed E, Hartmann B, Aleksanyan A, Stoelben E, Wappler F, Defosse JM. Airway Management by Laryngeal Mask Airways for Cervical Tracheal Resection and Reconstruction. Anesth Analg 2018; 126:1257-1261. [DOI: 10.1213/ane.0000000000002753] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rodrigo-Mocholi D, Brunel L. An emergency airway management system to improve fresh gas delivery in a dog undergoing tracheal resection. Vet Anaesth Analg 2018; 45:234-235. [PMID: 29428301 DOI: 10.1016/j.vaa.2017.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 09/26/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Diego Rodrigo-Mocholi
- Department of Veterinary Anaesthesia and Analgesia, Veterinary Teaching Hospital, University of Sydney, Sydney, Australia.
| | - Laurencie Brunel
- Department of Small Animal Surgery, Veterinary Teaching Hospital, University of Sydney, Sydney, Australia
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Kocher GJ, Dorn P. Minimally invasive resection and reconstruction of the intrathoracic trachea and carina. J Thorac Dis 2017; 9:4319-4322. [PMID: 29268499 DOI: 10.21037/jtd.2017.10.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Gregor J Kocher
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
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30
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Popescu WM, Heerdt PM. Bridging the Educational Gap in Thoracic Anesthesia. J Cardiothorac Vasc Anesth 2017; 31:1359-1360. [DOI: 10.1053/j.jvca.2017.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Indexed: 11/11/2022]
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