Original Article| Volume 36, ISSUE 10, P3817-3823, October 2022

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


      The evaluation of the use of laryngeal mask airways (LMA) as an alternative form of airway management for surgical tracheal reconstruction.


      A prospective case series.


      At a single German university hospital.


      Ten patients.


      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.


      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

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        • Baumann J
        • Forster J
        L'anesthésia en chirurgie trachéale.
        Poumon Coeur. 1960; 16: 19-32
        • Grillo HC.
        Development of tracheal surgery: A historical review. Part 1: Techniques of tracheal surgery.
        Ann Thorac Surg. 2003; 75: 610-619
        • Cervi E
        • Ong C.
        Tracheal resection: The team brief in multi-stage airway surgery.
        Anaesth Rep. 2020; 8: 22-25
        • Schieren M
        • Egyed E
        • Hartmann B
        • et al.
        Airway management by laryngeal mask airways for cervical tracheal resection and reconstruction: A single-center retrospective analysis.
        Anesth Analg. 2018; 126: 1257-1261
        • Schieren M
        • Bohmer A
        • Dusse F
        • et al.
        New approaches to airway management in tracheal resections-a systematic review and meta-analysis.
        J Cardiothorac Vasc Anesth. 2017; 31: 1351-1358
        • Pranit P
        • Sakthirajan P
        • Priya R.
        Entrapped tracheal tube, an unusual cause of extubation failure following tracheal resection and reconstruction.
        Ann Card Anaesth. 2020; 23: 250-251
        • Caronia FP
        • Loizzi D
        • Nicolosi T
        • et al.
        Tubeless tracheal resection and reconstruction for management of benign stenosis.
        Head Neck. 2017; 39: E114-E117
        • Macchiarini P
        • Rovira I
        • Ferrarello S.
        Awake upper airway surgery.
        Ann Thorac Surg. 2010; 89 (discussion 390-1): 387-390
        • Kar P
        • Malempati AR
        • Durga P
        • et al.
        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
        • Chen Y
        • Liao H
        • Niu Y
        • et al.
        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
        • Liu X
        • Jiang R
        • Xiao J
        • et al.
        Anesthesia airway management for tracheal resection and reconstruction: A single-center case series.
        Ann Palliat Med. 2021; 10: 3354-3363
        • Ferreirinha J
        • Caviezel C
        • Weder W
        • et al.
        Postoperative outcome of tracheal resection in benign and malignant tracheal stenosis.
        Swiss Med Wkly. 2020; 150: w20383
        • Zhou Y
        • Liu H
        • Wu X
        • et al.
        Spontaneous breathing anesthesia for cervical tracheal resection and reconstruction.
        J Thorac Dis. 2019; 11: 5336-5342
        • Schweiger T
        • de Faria Soares Rodrigues I
        • Roesner I
        • et al.
        Laryngeal mask as the primary airway device during laryngotracheal surgery: Data from 108 patients.
        Ann Thorac Surg. 2020; 110: 251-257
        • Kampe S
        • Rocha M
        • Darwiche K
        • et al.
        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
        • Cook TM
        • Alexander R.
        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
        • Auchincloss HG
        • Wright CD.
        Complications after tracheal resection and reconstruction: Prevention and treatment.
        J Thorac Dis. 2016; 8: S160-S167
        • Cardoso PFG
        • Bibas BJ
        • Minamoto H
        • et al.
        Prophylaxis and treatment of complications after tracheal resection.
        Thorac Surg Clin. 2018; 28: 227-241
        • Esakov YS
        • Pechetov AA
        • Khlan TN
        • et al.
        Circular tracheal resection for acquired tracheal stenosis: evaluation of early and long-term outcomes [article in Russian].
        Khirurgiia (Mosk). 2019; : 19-25
        • Okuda K
        • Moriyama S
        • Haneda H
        • et al.
        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
        • Stanifer BP
        • Andrei AC
        • Liu M
        • et al.
        Short-term outcomes of tracheal resection in the society of thoracic surgeons database.
        Ann Thorac Surg. 2018; 106: 1612-1618

      Linked Article

      • Airway Management for Tracheal Resections – Comments on a Controversial Approach
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 37Issue 1
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          I 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.
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