Laryngeal mask versus endotracheal tube for airway management in tracheal surgery: a case-control matching analysis and review of the current literature

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.

Airway management by i-gel for open tracheal resection and reconstruction via combined cervicotomy and sternotomy surgical approach: A case report

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.

Single-Lumen Endotracheal Tube and Bronchial Blocker for Airway Management During Tracheobronchoplasty for Tracheobronchomalacia: A Case Report

We present a case of a 69-year-old man who underwent tracheobronchoplasty for tracheobronchomalacia using a single-lumen endotracheal tube and a Y-shaped bronchial blocker for airway management. Tracheobronchoplasty is performed by sewing mesh to plicate the posterior, membranous wall of the distal trachea and main bronchi through a right posterolateral thoracotomy. The goals of airway management include continuous left-lung ventilation and lung protection from aspiration. Ideally, only conventional airway management tools are used. This case demonstrates that a single-lumen endotracheal tube with a bronchial blocker can be a straightforward strategy for airway management during tracheobronchoplasty.

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

Bronchial injuries are infrequently seen following blunt chest trauma and mostly have subtle clinical presentation. Its diagnosis is challenging and may be delayed resulting in myriad complications such as secondary infection, bronchiectasis, atelectasis, collapse, and fibrosis. We discuss the anesthetic management of a case of complete right principle bronchus transection with distal lung collapse, posted for surgical repair and highlight the unique intraoperative ventilation maneuver to identify the functional lung segment. This unique yet less recognized ventilation maneuver of the collapsed lung segment was performed just before bronchoplasty. The aforesaid maneuver may act as a pointer for further surgical course and a useful diagnostic and therapeutic modality in ensuring the eventual outcome in this subset of patients.

Assessment and Management of Post-Intubation Airway Injuries

Tracheal laceration is a known complication of endotracheal intubation. This rare complication remains a diagnostic and management challenge for today's practitioners. This clinical challenge report highlights current surgical and anesthetic management strategies.

Laryngotracheal resection and reconstruction

Patients with tracheal stenosis can experience life-threatening dyspnea. When the stenosis is close to the larynx, management can be challenging. Non-definitive palliative measures should be kept to a minimum as they can make definitive management more complicated. Specialized techniques of resection and reconstruction of high tracheal lesions are available and lead to excellent relief of symptoms. A detailed knowledge of the anatomy, the extent of the stenosis, and careful attention to surgical technique is crucial. Excellent results can be achieved in experienced centers that are able to anticipate and thus avoid complications that can be difficult to manage.