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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- L'anesthésia en chirurgie trachéale.Poumon Coeur. 1960; 16: 19-32
- Development of tracheal surgery: A historical review. Part 1: Techniques of tracheal surgery.Ann Thorac Surg. 2003; 75: 610-619
- Tracheal resection: The team brief in multi-stage airway surgery.Anaesth Rep. 2020; 8: 22-25
- Airway management by laryngeal mask airways for cervical tracheal resection and reconstruction: A single-center retrospective analysis.Anesth Analg. 2018; 126: 1257-1261
- New approaches to airway management in tracheal resections-a systematic review and meta-analysis.J Cardiothorac Vasc Anesth. 2017; 31: 1351-1358
- Entrapped tracheal tube, an unusual cause of extubation failure following tracheal resection and reconstruction.Ann Card Anaesth. 2020; 23: 250-251
- Tubeless tracheal resection and reconstruction for management of benign stenosis.Head Neck. 2017; 39: E114-E117
- Awake upper airway surgery.Ann Thorac Surg. 2010; 89 (discussion 390-1): 387-390
- Institution of cardiopulmonary bypass in an awake patient for resection of tracheal tumor causing near total luminal obstruction.J Anaesthesiol Clin Pharmacol. 2018; 34: 409-411
- Anesthetic consideration for airway management in patient undergoing tracheal resection and reconstruction for severe postintubation tracheal stenosis: A case report.Postgrad Med. 2021; 133: 544-547
- Anesthesia airway management for tracheal resection and reconstruction: A single-center case series.Ann Palliat Med. 2021; 10: 3354-3363
- Postoperative outcome of tracheal resection in benign and malignant tracheal stenosis.Swiss Med Wkly. 2020; 150: w20383
- Spontaneous breathing anesthesia for cervical tracheal resection and reconstruction.J Thorac Dis. 2019; 11: 5336-5342
- Laryngeal mask as the primary airway device during laryngotracheal surgery: Data from 108 patients.Ann Thorac Surg. 2020; 110: 251-257
- Sufficient high frequency jet ventilation during a period of 2.5 h - Airway management during resection of a tracheaesophageal fistula and tracheal resection [article in German].Anasthesiol Intensivmed Notfallmed Schmerzther. 2016; 51: 368-371
- Major complications during anaesthesia for elective laryngeal surgery in the UK: A national survey of the use of high-pressure source ventilation.Br J Anaesth. 2008; 101: 266-272
- Complications after tracheal resection and reconstruction: Prevention and treatment.J Thorac Dis. 2016; 8: S160-S167
- Prophylaxis and treatment of complications after tracheal resection.Thorac Surg Clin. 2018; 28: 227-241
- Circular tracheal resection for acquired tracheal stenosis: evaluation of early and long-term outcomes [article in Russian].Khirurgiia (Mosk). 2019; : 19-25
- Recent advances in video-assisted transthoracic tracheal resection followed by reconstruction under non-intubated anesthesia with spontaneous breathing.J Thorac Dis. 2017; 9: 2891-2894
- Short-term outcomes of tracheal resection in the society of thoracic surgeons database.Ann Thorac Surg. 2018; 106: 1612-1618
Article info
Publication history
Published online: May 29, 2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Airway Management for Tracheal Resections – Comments on a Controversial ApproachJournal of Cardiothoracic and Vascular AnesthesiaVol. 37Issue 1
- PreviewI have read with great interest the article by Defosse et al.1 As the authors emphasized, the number of tracheal resections is relatively modest and diverse practices described in the literature lack guidance from large conclusive trials.2 Nevertheless, studies with a few cases can provide valuable information for clinicians. The new approach in the author's study was the retrograde surgical insertion of airway exchange catheters (AECs) for high-frequency jet ventilation (HFJV), which seems to be somewhat complicated and may be risky.
- Full-Text
- Preview
