Abstract
Purpose
To review the literature on tracheal and carinal resection and reconstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The airway management is extensively reviewed.
Source
Articles obtained from a Medline search (1960 to October 1997; keywords: tracheal surgery, carinal surgery, airway management). Textbook literature including the bibliographies were also consulted.
Principal Findings
Benign or malignant tracheal and carinal pathology causing obstruction can be managed in several ways but resection and reconstruction are the treatment of choice for most patients with tracheal stenosis or tumour. Surgery of the trachea is a special endeavour where the airway is shared by the surgeon and the anesthesiologist. The principal anesthetic consideration is ventilation and oxygenation in the face of an open airway. Ventilation can be managed in different ways, including manual oxygen jet ventilation, high frequency jet ventilation, distal tracheal intubation, spontaneous ventilation, and cardiopulmonary bypass.
Conclusion
The management of anesthesia for tracheal surgery presents many challenges to the anesthesiologist. Knowledge of the various techniques for airway management is crucial. Meticulous planning and communication between the anesthesia and surgical teams are mandatory for the safe and successful outcome of surgery for patients undergoing this procedure.
Résumé
Objectif
Passer en revue la documentation concernant la résection trachéale et carénale ainsi que leur reconstruction, et indiquer la conduite à tenir dans ce cas avec les patients, aussi bien que les directives générales pour l’administration sécuritaire de l’anesthésie. La gestion des voies respiratoires a fait l’objet d’un examen poussé.
Sources
Des articles provenant d’une recherche dans Medline (1960 à octobre 1997; mots-clés: chirurgie de la trachée, chirurgie de la carène, gestion des voies respiratoires). Des monographies incluant les bibliographies ont aussi été consultées.
Constatations principales
La pathologie trachéale et carénale bénigne ou maligne causant de l’obstruction peut être traitée de différentes manières, mais la résection et la reconstruction sont le traitement de choix pour la plupart des patients atteints de sténose trachéale ou de tumeur. C’est une intervention spéciale où l’accès aux voies respiratoires est partagé par le chirurgien et l’anesthésiologiste. La considération anesthésique principale est la ventilation et l’oxygénation en présence de voies aériennes ouvertes. La ventilation jet manuelle avec de l’oxygène, la ventilation jet à haute fréquence, l’intubation trachéale distale, la ventilation spontanée et la circulation extracorporelle sont des variantes possibles de la ventilation dans ce cas.
Conclusion
La gestion de l’anesthésie lors d’intervention à la trachée représente de nombreux défis pour l’anesthésiologiste. La connaissance des diverses techniques de gestion des voies respiratoires est primordiale. Une planification méticuleuse et une bonne communication entre les équipes d’anesthésie et de chirurgie sont obligatoires pour assurer la sécurité des patients et le succès de ce genre d’intervention.
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References
Heitmiller RF. Tracheal release maneuvers. Chest Surg Clin N Am 1996; 6: 675–82.
Grillo HC. Tracheal anatomy and surgical approaches.In: Shields TW (Ed.). General Thoracic Surgery, 3rd ed. Philadelphia: Lea & Febiger, 1989: 406–15.
Grillo HC, Mathisen DJ. Disease of the trachea and bronchi.In: Paparella MM, Shumrick DA, Gluckman JL, Meyerhoff WL (Eds.). Otolaryngology, Head and Neck, 3rd ed. Philadelphia: WB Saunders Company, 1991; III: 2385–97.
Grillo HC. Benign and malignant diseases of the trachea.In: Shields TW (Ed.). General Thoracic Surgery, 3rd ed. Philadelphia: Lea & Febiger, 1989: 667–79.
Grillo HC, Donahue DM. Post intubation tracheal stenosis. Semin Thorac Cardiovasc Surg 1996; 8: 370–80.
Mathisen DJ. Tracheal tumors. Chest Surg Clin N Am 1996; 6: 875–98.
Mansour KA, Lee RB, Miller JI Jr. Tracheal resections: lessons learned. Ann Thorac Surg 1994; 57: 1120–4.
Grillo HC, Donahue DM. Postintubation tracheal stenosis. Chest Surg Clin N Am 1996; 6: 725–31.
Grillo HC, Mathisen DJ. Cervical exenteration. Ann Thorac Surg 1990; 49: 401–9.
Wilson RS. Tracheostomy and tracheal reconstruction.In: Kaplan JA (Ed.). Thoracic Anesthesia, 2nd ed. New York: Churchill Livingstone, 1991: 441–61.
Muehrcke DD, Grillo HC, Mathisen DJ. Reconstructive airway operation after irradiation. Ann Thorac Surg 1995; 59: 14–8.
Pearson FG, Gullane P. Subglottic resection with primary tracheal anastomosis: including synchronous laryngotracheal reconstructions. Semin Thorac Cardiovasc Surg 1996; 8: 381–91.
Grillo HC. Management of idiopathic tracheal stenosis. Chest Surg Clin N Am 1996; 6: 811–8.
Cooper JD, Pearson FG, Patterson GA, et al. Use of silicone stents in the management of airway problems. Ann Thorac Surg 1989; 47: 371–8.
Gaissert HA, Grillo HC, Mathisen DJ, Wain JC. Temporary and permanent restoration of airway continuity with the tracheal T-tube. J Thorac Cardiovasc Surg 1994; 107: 600–6.
Couraud L, Jougon J, Velly JF, Klein C. Iatrogenic stenoses of the airways. Surgical indications in a series of 217 cases. (French) Ann de Chir 1994; 48: 277–83.
Perelman MI, Koroleva N, Birjukov J, Goudovsky L. Primary tracheal tumors. Sem Thorac Cardiovasc Surg 1996; 8: 400–2.
Keshavjee S, Pearson FG. Tracheal resection.In: Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC Jr (Eds.). Thoracic Surgery, 1st ed. New York: Churchill Livingstone, 1995: 333–44.
Mathisen DJ. Complications of tracheal surgery. Chest Surg Clin N Am 1996; 6: 853–64.
Mathisen DJ. Carinal reconstruction: techniques and problems. Semin Thorac Cardiovasc Surg 1996; 8: 403–13.
Mathisen DJ, Grillo HC. Carinal resection.In: Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC Jr (Eds.). Thoracic Surgery, 1st ed. New York: Churchill Livingstone, 1995: 345–54.
Pearson FG. Technique of management of subglottic stenosis. Chest Surg Clin N Am 1996; 6: 683–92.
Geffin B, Bland J, Grillo HC. Anesthetic management of tracheal resection and reconstruction. Anesth Analg 1969; 48: 884–90.
Benumof JL. Anesthesia for special elective therapeutic procedures.In: Benumof JL (Ed.). Anesthesia for Thoracic Surgery, 2nd ed. Philadelphia: W.B. Saunders Company, 1995: 513–90.
Behringer EC, Wilson RS. Tracheal resection and reconstruction.In: Cohen E (Ed.). The Practice of Thoracic Anesthesia, 1st ed. Philadelphia: J.B. Lippincott Company, 1995: 531–62.
Dartevelle P, Macchiarini P. Carinal resection for bronchogenic cancer. Semin Thorac Cardiovasc Surg 1996; 8: 414–25.
Donlon JV Jr. Anesthesia and eye, ear, nose, and throat surgery.In: Miller RD (Ed.). Anesthesia, 4th ed. New York: Churchill Livingstone, 1994; 2: 2175–96.
Froelich J, Eagle CJ. Anaesthetic management of a patient with myasthenia gravis and tracheal stenosis. Can J Anaesth 1996; 43: 84–9.
Kamvyssi-Dea S, Kritikou P, Exarhos N, Skalkeas G. Anaesthetic management of reconstruction of the lower portion of the trachea. Case report. Br J Anaesth 1975; 47: 82–4.
Dodge TL, Mahaffey JE, Thomas JD. The anesthetic management of a patient with an obstructing intratracheal mass: a case report. Anesth Analg 1977; 56: 295–8.
Baraka A. Oxygen-jet ventilation during tracheal reconstruction in patients with tracheal stenosis. Anesth Analg 1977; 56: 429–32.
Abou-Madi MN, Cuadrado L, Domb B, Barnes J, Trop D. Anaesthesia for tracheal resection: a new way to manage the airway. Can Anaesth Soc J 1979; 26: 26–8.
Baraka A, Mansour R, Jaoude CA, Muallem M, Hatem J, Jaraki K. Entrainment of oxygen and halothane during jet ventilation in patients undergoing excision of tracheal and bronchial tumors. Anesth Analg 1986; 65: 191–4.
Perera ER, Vidic DM, Zivot J. Carinal resection with two high-frequency jet ventilation delivery systems. Can J Anaesth 1993; 40: 59–63.
Lippmann M, Mok MS. Tracheal cylindroma: anaesthetic management. Br J Anaesth 1977; 49: 383–6.
El-Baz N, Holinger L, El-Ganzouri A, Gottschalk W, Ivankovich AD. High-frequency positive-pressure ventilation for tracheal reconstruction supported by tracheal T-tube. Anesth Analg 1982; 61: 796–800.
Crinquette V, Wurtz A, Leroy S, Dalmas S. Separate two lung high frequency jet ventilation for carinal resection and reconstruction. (French) Ann de Chir 1989; 43: 673–6.
Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995; 109: 486–92.
Maddaus M, Pearson FG. Subglottic resection.In: Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC Jr (Eds.). Thoracic Surgery, 1st ed. New York: Churchill Livingstone, 1995: 321–33.
Lee P, English ICW. Management of anaesthesia during tracheal resection. Anaesthesia 1974; 29: 305–6.
Ellis RH, Hinds CJ, Gadd LT. Management of anaesthesia during tracheal resection. Anaesthesia 1976; 31: 1076–80.
Clarkson WB, Davies JR. Anaesthesia for carinal resection. Anaesthesia 1978; 33: 815–9.
Vyas AB, Lyons SM, Dundee JW. Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis. Anaesthesia 1983; 38: 132–5.
Rogers RC, Gibbons J, Cosgrove J, Coppel DL. High-frequency jet ventilation for tracheal surgery. Anaesthesia 1985; 40: 32–6.
Watanabe Y, Murakami S, Iwa T, Murakami S. The clinical value of high-frequency jet ventilation in major airway reconstructive surgery. Scand J Thorac Cardiovasc Surg 1988; 22: 227–33.
Neuman GG, Asher AS, Stern SB, Wenig BL, Morgan QL. High-frequency jet ventilation for tracheal resection in a child. Anesth Analg 1984; 63: 1039–40.
MacNaughton FI. Catheter inflation ventilation in tracheal stenosis. Br J Anaesth 1975; 47: 1225–7.
Eriksson I, Nilsson L-G, Nordström S, Sjöstrand U. High-frequency positive-pressure ventilation (HFPPV) during transthoracic resection of tracheal stenosis and during peroperative bronchoscopic examination. Acta Anaesthesiol Scand 1975; 19: 113–9.
El-Baz N, Jensik R, Faber LP, Faro RS. One-lung highfrequency ventilation for tracheoplasty and bronchoplasty: a new technique. Ann Thorac Surg 1982; 34: 564–71.
Pearson FG, Todd TRJ, Cooper JD. Experience with primary neoplasms of the trachea and carina. J Thorac Cardiovasc Surg 1984; 88: 511–8.
Regnard JF, Fourquier P, Levasseur P. Results and prognostic factors in resections of primary tracheal tumors: a multicenter retrospective study. J Thorac Cardiovasc Surg 1996; 111: 808–14.
Glenski JA, Crawford M, Rehder K. High-frequency, small-volume ventilation during thoracic surgery. Anesthesiology 1986; 64: 211–4.
Belsey R. Resection and reconstruction of the intrathoracic trachea. Br J Surg 1950; 38: 200–5.
Pearson FG, Brito-Filomeno L, Cooper JD. Experience with partial cricoid resection and thyrotracheal anastomosis. Ann Otol Rhinol Laryngol 1986; 95: 582–5.
Debrand M, Tsueda K, Browning SK, Wright BD, Todd EP. Anesthesia for extensive resection of congenital tracheal stenosis in an infant. Anesth Analg 1979; 58: 431–3.
Grillo HC, Mathisen DJ. Surgical management of tracheal strictures. Surg Clin North Am 1988; 68: 511–24.
Grillo HC. Slide tracheoplasty for long-segment congenital tracheal stenosis. Ann Thorac Surg 1994; 58: 613–9.
Maziak DE, Todd TRJ, Keshavjee SH, Winton TL, Nostrand PV, Pearson FG. Adenoid cystic carcinoma of the airway: thirty-two-year experience. J Thorac Cardiovasc Surg 1996; 112: 1522–31.
Theman TE, Kerr JH, Nelems JM, Pearson FG. Carinal resection. A report of two cases and a description of the anesthetic technique. J Thorac Cardiovasc Surg 1976; 71: 314–20.
McClish A, Deslauriers J, Beaulieu M, et al. High-flow catheter ventilation during major tracheobronchial reconstruction. J Thorac Cardiovasc Surg 1985; 89: 508–12.
Hannallah MS. The optimal breathing tube for tracheal resection and reconstruction. Anesthesiology 1995; 83: 419–21.
Joynt GM, Chui PT, Mainland P, Abdullah V. Total intravenous anesthesia and endotracheal oxygen insufflation for repair of tracheoesophageal fistula in an adult. Anesth Analg 1996; 82: 661–3.
Woods FM, Neptune WB, Palatchi A. Resection of the carina and main-stem bronchi with the use of extracorporeal circulation. N Engl J Med 1961; 264: 492–4.
Adkins PC, Izawa EM. Resection of tracheal cylindroma using cardiopulmonary bypass. Arch Surg 1964; 88: 405–9.
Neville WE, Thomason RD, Peacock H, Colby C. Cardiopulmonary bypass during noncardiac surgery. Arch Surg 1966; 92: 576–86.
Grillo HC. Carinal reconstruction. Ann Thorac Surg 1982; 34: 356–73.
Coles JC, Doctor A, Lefcoe M, Butlin G. A method of anesthesia for imminent tracheal obstruction. Surgery 1976; 80: 379–81.
Wilson RF, Steiger Z, Jacobs J, Sison OS, Holsey C. Temporary partial cardiopulmonary bypass during emergency operative management of near total tracheal occlusion. Anesthesiology 1984; 61: 103–5.
Benca JF, Mickey PR, Dornbusch JN, Koka BV, McGill TJ, Jonas R. Ventilatory management assisted by cardiopulmonary bypass for distal tracheal reconstruction in a neonate. Anesthesiology 1988; 68: 270–1.
Grillo HC, Zannini P, Michelassi F. Complications of tracheal reconstruction. Incidence, treatment, and prevention. J Thorac Cardiovasc Surg 1986; 91: 322–8.
Borrelly J, Simon CI, Bertrand P. Cases of regressive paraplegia after repeated resection of the trachea. One case. (French) Ann de Chir 1981; 35: 618–9.
Pitz CCM, Duurkens VAM, Goossens DJA, Knaepen PJ, Siegers P, Hoogenboom LJ. Tetraplegia after a tracheal resection procedure. Chest 1994; 106: 1264–5.
Domínguez J, Rivas JJ, Lobato RD, Diaz V, Larrú E. Irreversible tetraplegia after tracheal resection. Ann Thorac Surg 1996; 62: 278–80.
Grillo HC, Mathisen DJ. Primary tracheal tumors: treatment and results. Ann Thorac Surg 1990; 49: 69–77.
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Pinsonneault, C., Fortier, J. & Donati, F. Tracheal resection and reconstruction. Can J Anesth 46, 439–455 (1999). https://doi.org/10.1007/BF03012943
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DOI: https://doi.org/10.1007/BF03012943