A New Approach in Airway Management for Tracheal Resection and Anastomosis: A Single-Center Prospective Study

[Anesthesia and Surgery of the Trachea]

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.

Tracheal regeneration and mesenchymal stem cell augmenting potential of natural polyphenol-loaded gelatinmethacryloyl bioadhesive

Hydrogels incorporating natural biopolymer and adhesive substances have extensively been used to develop bioactive drugs and to design cells encapsulating sturdy structure for biomedical applications. However, the conjugation of the adhesive in most hydrogels is insufficient to maintain long-lasting biocompatibility inadequate to accelerate internal organ tissue repair in the essential native cellular microenvironment. The current work elaborates the synthesis of charged choline-catechol ionic liquid (BIL) adhesive and a hydrogel with an electronegative atom rich polyphenol (PU)-laden gelatinmethacryloyl (GelMA) to improve the structural bioactivities for in vivo tracheal repair by inducing swift crosslinking along with durable mechanical and tissue adhesive properties. It was observed that bioactive BIL and PU exhibited potent antioxidant (IC 50 % of 7.91 μg/mL and 24.55 μg/mL) and antibacterial activity against E. coli, P. aeruginosa and S. aureus. The novel integration of photocurable GelMA-BIL-PU revealed outstanding mechanical strength, biodegradability and sustained drug release. The in vitro study showed exceptional cell migration and proliferation in HBECs, while in vivo investigation of the GelMA-BIL-PU hydrogel on a rat's tracheal model revealed remarkable tracheal reconstruction, concurrently reducing tissue inflammation. Furthermore, the optimized GelMA-BIL-PU injectable adhesive bioink blend demonstrated superior MSCs migration and proliferation, which could be a strong candidate for developing stem cell-rich biomaterials to address multiple organ defects.

The Year in Thoracic Anesthesia: Selected Highlights from 2022

This article reviews research highlights in the field of thoracic anesthesia. The highlights of this year included new developments in the preoperative assessment and prehabilitation of patients requiring thoracic surgery, updates on the use of devices for one-lung ventilation (OLV) in adults and children, updates on the anesthetic and postoperative management of these patients, including protective OLV ventilation, the use of opioid-sparing techniques and regional anesthesia, and outcomes using enhanced recovery after surgery, as well as the use of expanding indications for extracorporeal membrane oxygenation, specialized anesthetic techniques for airway surgery, and nonintubated video-assisted thoracic surgery.

[Management of Tracheobronchial Stenoses]

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.

ANESTHESIA FOR NON-INTUBATED VIDEO-ASSISTED THORACOSCOPIC SURGERY

With the growing adoption of Enhanced Recovery After Surgery protocols across all surgical groups, including thoracic surgery, coupled with improved video-assisted thoracoscopic surgery (VATS) equipment and techniques, nonintubated thoracoscopic surgery has gained significant popularity in recent years. Avoiding tracheal intubation with an endotracheal or double-lumen tube and general anesthesia may reduce or eliminate the risks associated with traditional mechanical ventilation, one-lung ventilation, and general anesthesia. Studies have shown a trend toward better preservation of postoperative respiratory function and improved postoperative lengths of hospital stay, morbidity, and mortality; however, these have not been conclusively proven. This review article discusses the advantages of nonintubated VATS, the types of thoracic surgery in which this technique has been described, patient selection, appropriate anesthetic techniques, surgical concerns, potential complications relevant to the anesthesiologist during the conduct of nonintubated VATS surgery, and suggested management of these complications.