Skip to main content
SpringerLink
Log in

Tracheal Resection and Reconstruction

  • Chapter
  • First Online:
Principles and Practice of Anesthesia for Thoracic Surgery

Abstract

The tracheal imaging (CT scan and/or MRI) must be examined by the anesthesiologist to plan the anesthetic management. Patients with tracheal stenosis may not become symptomatic until the tracheal diameter is narrowed to <50% of normal. Initial surgical management for tracheal stenosis will commonly involve rigid bronchoscopy and dilation. The two major methods of distal airway management for resection of tracheal stenosis are cross-field ventilation with an endotracheal tube or jet ventilation with a tracheal catheter. Maintenance of anesthesia during the period of tracheal resection is commonly managed with an intravenous infusion technique.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Belsey R. Resection and reconstruction of the intrathoracic trachea. Br J Surg. 1950;38:200.

    Article  CAS  PubMed  Google Scholar 

  2. Barclay RS, McSwan N, Welsh TH. Tracheal reconstruction without the use of grafts. Thorax. 1957;12:177.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Grillo HC, Bendixen HH, Gephart T. Resection of the carina and lower trachea. Ann Surg. 1963;158:889.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Geffin B, Bland J, Grillo HC. Anesthetic management of tracheal resection and reconstruction. Anesth Analg. 1969;48:884.

    Article  CAS  PubMed  Google Scholar 

  5. Cooper JD, Grillo HC. The evolution of tracheal injury due to ventilator assistance through cuffed tubes: a pathological study. Ann Surg. 1969;169:334–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Liu J, Zhang X, Gong W, et al. Correlations between controlled endotracheal tube cuff pressure and post procedural complications: a multicenter study. Anesth Analg. 2010;111:1133–7.

    Article  PubMed  Google Scholar 

  7. Grillo HC, Mathisen DJ. Cervical exenteration. Ann Thorac Surg. 1990;49:401.

    Article  CAS  PubMed  Google Scholar 

  8. Miura T, Grillo HC. The contribution of the inferior thyroid artery to the blood supply of the human trachea. Surg Gynecol Obstet. 1966;123:99–102.

    CAS  PubMed  Google Scholar 

  9. Minnich DJ, Mathisen DJ. Anatomy of the trachea, carina, and bronchi. Thorac Surg Clin. 2007;17:571–85.

    Article  PubMed  Google Scholar 

  10. Pearson FG, Cooper JD, Nelems JM, et al. Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves. J Thorac Cardiovasc Surg. 1975;70:806–16.

    CAS  PubMed  Google Scholar 

  11. Agrawal S, Payal YS, Sharma JP, et al. Montgomery T-tube: anesthetic management. J Clin Anesth. 2007;19:135–7.

    Article  PubMed  Google Scholar 

  12. Merritt RE, Mathisen DJ. Tracheal resection. In: Patterson GA, Cooper JD, Deslauriers J, et al., editors. Pearson’s thoracic and esophageal surgery. 3rd ed. Philadelphia: Churchill Livingston; 2008. p. 377–82.

    Google Scholar 

  13. Fabre D, Fadel E, Mussot S, et al. Autologous tracheal replacement for cancer. Chin Clin Oncol. 2015;4(4):46.

    PubMed  Google Scholar 

  14. Macchiarini P, Jungebluth P, Go T, et al. Clinical transplantation of a tissue-engineered airway. Lancet. 2008;372:2023–30.

    Article  PubMed  Google Scholar 

  15. De Perrot M, Fadel E, Dartevelle P. Carinal resection. In: Patterson GA, Cooper JD, Deslauriers J, et al., editors. Pearson’s thoracic and esophageal surgery. 3rd ed. Philadelphia: Churchill Livingstone; 2008. p. 383–92.

    Chapter  Google Scholar 

  16. Wright C, Grillo H, Wain JC, et al. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg. 2004;128:731–9.

    Article  PubMed  Google Scholar 

  17. Young-Beyer P, Wilson RS. Anesthetic management for tracheal resection and reconstruction. J Cardiothorac Anesth. 1988;2:821–35.

    Article  CAS  PubMed  Google Scholar 

  18. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.

    Article  CAS  PubMed  Google Scholar 

  19. Tomori Z, Widdicombe JG. Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol. 1969;200:25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hill AJ, Feneck RO, Underwood SM, et al. The haemodynamic effects of bronchoscopy, comparison of propofol and thiopentone with and without alfentanil pretreatment. Anaesthesia. 1991;46:266–70.

    Article  CAS  PubMed  Google Scholar 

  21. De Perrot M, Fadel E, Mercier O, et al. Long term results after carinal resection for carcinoma. J Thorac Cardiovasc Surg. 2006;131:81–9.

    Article  PubMed  Google Scholar 

  22. Licker M, Schweizer A, Nicolet G, et al. Anesthesia of a patient with an obstructing tracheal mass: a new way to manage the airway. Acta Anaesthesiol Scand. 1997;41:34.

    Article  Google Scholar 

  23. Pinsonneault C, Fortier J, Donati F. Tracheal resection and reconstruction. Can J Anaesth. 1999;46:439.

    Article  CAS  PubMed  Google Scholar 

  24. Fischler M, Troche G, Guerin Y, et al. Evolution des techniques d’anesthesie pour resection-anastamose de trachee. Ann Fr Anesth Reanim. 1988;7:125–7.

    Article  CAS  PubMed  Google Scholar 

  25. Conacher ID, Velasquez H, Morrice DJ. Endobronchial tubes – a case for re-evaluation. Anaesthesia. 2006;61:587.

    Article  CAS  PubMed  Google Scholar 

  26. Hannallah MS. The optimal breathing tube for tracheal resection and reconstruction. Anesthesiology. 1995;83:419.

    Article  CAS  PubMed  Google Scholar 

  27. Theman TE, Kerr JH, Nelems JM, et al. Carinal resection, a report of two cases and a description of the anesthetic technique. J Thorac Cardiovasc Surg. 1976;71:314.

    CAS  PubMed  Google Scholar 

  28. Sanders RD. Two ventilating attachments for bronchoscopes. Del Med J. 1967;39:170–3.

    Google Scholar 

  29. Lee P, English ICW. Management of anesthesia during tracheal resection. Anaesthesia. 1974;29:305.

    Article  CAS  PubMed  Google Scholar 

  30. Ellis RH, Hinds CJ, Gadd LT. Management of anaesthesia during tracheal resection. Anaesthesia. 1976;31:1076.

    Article  CAS  PubMed  Google Scholar 

  31. McClish A, Deslauriers J, Beaulieu M, et al. High-flow catheter ventilation during major tracheobroncheal reconstruction. J Thorac Cardiovasc Surg. 1985;89:508.

    CAS  PubMed  Google Scholar 

  32. Baraka A. Oxygen-jet ventilation during tracheal reconstruction in patients with tracheal stenosis. Anesth Analg. 1977;56:429.

    CAS  PubMed  Google Scholar 

  33. Clarkson WB, Davies JR. Anaesthesia for carinal resection. Anaesthesia. 1978;33:815.

    Article  CAS  PubMed  Google Scholar 

  34. Carlon GC, Kahn RC, Howland WS, et al. Clinical experience with high frequency ventilation. Crit Care Med. 1981;9:1.

    Article  CAS  PubMed  Google Scholar 

  35. Howland WS, Carlon GC, Goldiner PL, et al. High-frequency jet ventilation during thoracic surgical procedures. Anesthesiology. 1987;67:1009.

    Article  CAS  PubMed  Google Scholar 

  36. Sjostrand U. High-frequency positive-pressure ventilation: a review. Crit Care Med. 1980;8:345.

    Article  CAS  PubMed  Google Scholar 

  37. Glenski JA, Crawford M, Rehder K. High-frequency, small volume ventilation during thoracic surgery. Anesthesiology. 1980;59:577.

    Google Scholar 

  38. Carlon GC, Griffin J, Ray C Jr. High-frequency jet ventilation in experimental airway disruption. Crit Care Med. 1983;11:353–5.

    Article  CAS  PubMed  Google Scholar 

  39. Beamer WC, Prough DS, Royster RL, et al. High-frequency jet ventilation produces auto-PEEP. Crit Care Med. 1984;12:734.

    Article  CAS  PubMed  Google Scholar 

  40. Froese AS, Bryan AC. High frequency ventilation. Am Rev Respir Dis. 1987;135:1363.

    Article  CAS  PubMed  Google Scholar 

  41. Adelsmayr E, Keller C, Erd G, et al. The laryngeal mask and high-frequency jet ventilation for resection of high tracheal stenosis. Anesth Analg. 1998;86:907.

    Article  CAS  PubMed  Google Scholar 

  42. Watanabe Y, Murakami S, Iwa T, et al. The clinical value of high-frequency jet ventilation in major airway reconstructive surgery. Scand J Thorac Cardiovasc Surg. 1988;22:227.

    Article  CAS  PubMed  Google Scholar 

  43. Magnusson L, Lang FJW, Monnier P, et al. Anaesthesia for tracheal resection: report of 17 cases. Can J Anaesth. 1997;44:1282.

    Article  CAS  PubMed  Google Scholar 

  44. Perera ER, Vidic DM, Zivot J. Carinal resection with two high-frequency jet ventilation delivery systems. Can J Anaesth. 1993;40:59.

    Article  CAS  PubMed  Google Scholar 

  45. Galmén K, Harbut P, Freedman J, et al. The use of high-frequency ventilation during general anaesthesia: an update. F1000Res. 2017;6(F1000 Faculty Rev):756. https://doi.org/10.12888/f1000research.10823.1.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Eriksson I, Nilson LG, Nordstrom S. High-frequency positive-pressure ventilation during transthoracic resection of tracheal stenosis and during preoperative bronchoscopic examination. Acta Anaesthesiol Scand. 1975;19:113.

    Article  CAS  PubMed  Google Scholar 

  47. El-Baz N, Holinger L, El-Ganzouri A. High-frequency positive-pressure ventilation for tracheal reconstruction supported by tracheal T-tube. Anesth Analg. 1982;61:796.

    Article  CAS  PubMed  Google Scholar 

  48. El-Baz N, El-Ganzouri A, Gottschalk W, et al. One-lung high frequency positive pressure ventilation for sleeve pneumonectomy: an alternative technique. Anesth Analg. 1981;60:683.

    Article  CAS  PubMed  Google Scholar 

  49. El-Baz N, Jensik R, Penfield Faber L, et al. One-lung high-frequency ventilation for tracheoplasty and bronchoplasty: a new technique. Ann Thorac Surg. 1982;34:564.

    Article  CAS  PubMed  Google Scholar 

  50. Baraka A, Mansour R, Jaoude CA, et al. Entrainment of oxygen and halothane during jet ventilation in patients undergoing excision of tracheal and bronchial tumors. Anesth Analg. 1986;65:191.

    Article  CAS  PubMed  Google Scholar 

  51. Louhimo I, Leijala M. Cardiopulmonary bypass in tracheal surgery in infants and small children. Prog Pediatr Surg. 1987;21:58–63.

    Article  CAS  PubMed  Google Scholar 

  52. Benca JF, Hickey PR, Dornbusch JN, et al. Ventilatory management assisted by cardiopulmonary bypass for distal tracheal reconstruction in a neonate. Anesthesiology. 1988;68:270.

    Article  CAS  PubMed  Google Scholar 

  53. Ernst M, Koller M, Grobholtz R, et al. Both atrial resection and superior vena cava replacement in sleeve pneumonectomy for advanced lung cancer. Eur J Cardiothorac Surg. 1999;15:530.

    Article  CAS  PubMed  Google Scholar 

  54. Symbas PN, Justicz AG, Ricketts RR. Rupture of the airways from blunt trauma: treatment of complex injuries. Ann Thorac Surg. 1992;54:177–80.

    Article  CAS  PubMed  Google Scholar 

  55. Wilson RF, Steiger Z, Jacobs J, et al. Temporary partial cardiopulmonary bypass during emergency operative management of near total tracheal occlusion. Anesthesiology. 1984;61:103.

    Article  CAS  PubMed  Google Scholar 

  56. Hasegawa T, Oshima Y, Matsuihisa H, et al. Clinical equivalency of cardiopulmonary bypass and extracorporeal membrane oxygenation support for pediatric tracheal reconstruction. Pediatr Surg Int. 2016;32:1029–36.

    Article  PubMed  Google Scholar 

  57. Kim CW, Kim DH, Son BS, et al. The feasibility of extracorporeal membrane oxygenation in the variant airway problems. Ann Thorac Cardiovasc Surg. 2015;21:517–22.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Vyas AB, Lyons SM, Dundee JW. Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis. Anaesthesia. 1983;38:132.

    Article  CAS  PubMed  Google Scholar 

  59. Pittoni G, Davia G, Tottoletto F. Spontaneous ventilation and epidural anesthesia in a patient with a large tracheoesophageal fistula and esophageal cancer undergoing colonic interposition. Anesthesiology. 1993;79:855.

    Article  CAS  PubMed  Google Scholar 

  60. Macchiarini P, Rovira I, Ferrarello S. Awake upper airway surgery. Ann Thorac Surg. 2010;89:387–91.

    Article  PubMed  Google Scholar 

  61. Liu J, Li S, Shen J, et al. Non-intubated resection and reconstruction of the trachea for the treatment of a mass of the upper trachea. J Thorac Dis. 2016;8:594–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Li S, Liu J, He J, et al. Video-assisted transthoracic surgery resection of a tracheal mass and reconstruction of trachea under non-intubated anesthesia with spontaneous ventilation. J Thorac Dis. 2016;8:575–85.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Peng G, Cui F, Ang KL, et al. Non-intubated combined with video-assisted thoracoscopic in carinal reconstruction. J Thorac Dis. 2016;8:586–93.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Ratzenhofer-Komenda B, Offner A, Kaltenbock F, et al. Differential lung ventilation and emergency hyperbaric oxygenation for repair of a tracheal tear. Can J Anaesth. 2000;47:169.

    Article  CAS  PubMed  Google Scholar 

  65. Nouraei SAR, Giussani DA, Howard DJ, et al. Physiological comparison of spontaneous and positive-pressure ventilation in laryngotracheal stenosis. Br J Anaesth. 2008;101:419–23.

    Article  CAS  PubMed  Google Scholar 

  66. Abdelmalak B, Makary L, Hoban J, et al. Dexmedetomidine as sole sedative for awake intubation in management of the critical airway. J Clin Anesth. 2007;19:370–9.

    Article  CAS  PubMed  Google Scholar 

  67. Ramsay MAE, Saha D, Hebeler RF. Tracheal resection in the morbidly obese patient: the role of dexmedetomidine. J Clin Anesth. 2006;18:252–4.

    Article  CAS  Google Scholar 

  68. Hammer GB, Philip BM, Schroeder AR, et al. Prolonged infusion of dexmedetomidine for sedation following tracheal resection. Paediatr Anaesth. 2005;15:616–20.

    Article  PubMed  Google Scholar 

  69. Kailash F, DaSilva SL, Block FE. A novel approach to maintain positive pressure ventilation during difficult T-tube placement. Can J Anaesth. 2009;56:709–10.

    Article  PubMed  Google Scholar 

  70. Lane GA, Steude G, Pashley NRT. Anesthesia for a patient with a tracheal T-tube stent. Anesth Analg. 1981;60:218.

    Article  CAS  PubMed  Google Scholar 

  71. Baraka A, Muallem M, Noueihid R, et al. Oxygen jet ventilation of patients with tracheal T-tube. Anesth Analg. 1982;61:622.

    CAS  PubMed  Google Scholar 

  72. Doyle DJ, O’Grady KF. Physics and the airway; essentials for the clinician. The difficult airway I. Anesthesiol Clin North Am. 1995;13:277.

    Google Scholar 

  73. Lang SA, Duncan PG, Shepard DAE, et al. Pulmonary oedema associated with airway obstruction. Can J Anaesth. 1990;37:201.

    Article  Google Scholar 

  74. Koch SM, Abramson DC, Ford M, et al. Bronchoscopic findings in post-obstructive pulmonary oedema. Can J Anaesth. 1996;43:73.

    Article  CAS  PubMed  Google Scholar 

  75. Mussi A, Ambrogi MC, Menconi G, et al. Surgical approaches to membranous tracheal wall lacerations. J Thorac Cardiovasc Surg. 2000;120:115.

    Article  CAS  PubMed  Google Scholar 

  76. Devitt JH, Boulanger BR. Lower airway injuries and anaesthesia. Can J Anaesth. 1996;43:148–59.

    Article  CAS  PubMed  Google Scholar 

  77. Abernathy JH, Reeves ST. Airway catastrophes. Curr Opin Anesthesiol. 2010;23:41–6.

    Article  Google Scholar 

  78. Johnson AP, Cavarocchi NC, Hirose H. Ventilator strategies for VV ECMO management with concomitant tracheal injury and H1N1 influenza. Heart Lung Vessel. 2015;7:74–80.

    PubMed  PubMed Central  Google Scholar 

  79. Salem MR, Wong AY, Lin YH, et al. Prevention of gastric distension during anesthesia for newborns with tracheoesophageal fistulas. Anesthesiology. 1973;38:82.

    Article  CAS  PubMed  Google Scholar 

  80. Au CL, White SA, Grant RP. A novel intubation technique for tracheoesophageal fistula in adults. Can J Anaesth. 1999;46:688.

    Article  CAS  PubMed  Google Scholar 

  81. Manning PB, Rutter MJ, Border WL. Slide tracheoplasty in infants and children: risk factors for prolonged postoperative ventilatory support. Ann Thorac Surg. 2008;85:1187–92.

    Article  PubMed  Google Scholar 

  82. Fanous N, Adil Husain S, Ruzmetov M, Rodefeld MD, Turrentine MW, Brown JW. Anterior pericardial tracheoplasty for long-segment tracheal stenosis. J Thorac Cardiovasc Surg. 2010;139:18–25.

    Article  PubMed  Google Scholar 

  83. Wouters KMA, Byreddy R, Gleeson M, et al. New approach to anesthetizing a patient at risk of pulmonary aspiration with a Montgomery T-tube in situ. Br J Anaesth. 2008;101:354–7.

    Article  CAS  PubMed  Google Scholar 

  84. Hantler C, Wildes TS, Andritsos M. Anesthesia for airway surgery. In: Patterson AG, editor. Pearson’s thoracic and esophageal surgery. Philadelphia: Elsevier; 2008. p. 211–30.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia and Pain Management, The Toronto General Hospital, University Health Network, Toronto, ON, Canada

    Karen McRae

Authors
  1. Karen McRae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen McRae .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University of Toronto, Toronto, ON, Canada

    Peter Slinger

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

McRae, K. (2019). Tracheal Resection and Reconstruction. In: Slinger, P. (eds) Principles and Practice of Anesthesia for Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-00859-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-00859-8_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-00858-1

  • Online ISBN: 978-3-030-00859-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation