Canadian Journal of Anesthesia

, Volume 46, Issue 5, pp 439–455 | Cite as

Tracheal resection and reconstruction

  • Céline Pinsonneault
  • Joanne Fortier
  • François Donati
Review Article

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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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Céline Pinsonneault
    • 1
  • Joanne Fortier
    • 1
  • François Donati
    • 1
  1. 1.CHUM (Campus Hôtel-Dieu)MontréalCanada

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