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Tracheal Resection and Reconstruction

  • Karen McRaeEmail author
Chapter

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.

Keywords

Open airway surgery Cross-field ventilation Jet ventilation Intraoperative ECMO Montgomery T-tube 

References

  1. 1.
    Belsey R. Resection and reconstruction of the intrathoracic trachea. Br J Surg. 1950;38:200.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Barclay RS, McSwan N, Welsh TH. Tracheal reconstruction without the use of grafts. Thorax. 1957;12:177.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Grillo HC, Bendixen HH, Gephart T. Resection of the carina and lower trachea. Ann Surg. 1963;158:889.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Geffin B, Bland J, Grillo HC. Anesthetic management of tracheal resection and reconstruction. Anesth Analg. 1969;48:884.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Grillo HC, Mathisen DJ. Cervical exenteration. Ann Thorac Surg. 1990;49:401.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 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.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Minnich DJ, Mathisen DJ. Anatomy of the trachea, carina, and bronchi. Thorac Surg Clin. 2007;17:571–85.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 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.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Agrawal S, Payal YS, Sharma JP, et al. Montgomery T-tube: anesthetic management. J Clin Anesth. 2007;19:135–7.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 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. 13.
    Fabre D, Fadel E, Mussot S, et al. Autologous tracheal replacement for cancer. Chin Clin Oncol. 2015;4(4):46.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Macchiarini P, Jungebluth P, Go T, et al. Clinical transplantation of a tissue-engineered airway. Lancet. 2008;372:2023–30.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Young-Beyer P, Wilson RS. Anesthetic management for tracheal resection and reconstruction. J Cardiothorac Anesth. 1988;2:821–35.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.CrossRefGoogle Scholar
  19. 19.
    Tomori Z, Widdicombe JG. Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol. 1969;200:25.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 23.
    Pinsonneault C, Fortier J, Donati F. Tracheal resection and reconstruction. Can J Anaesth. 1999;46:439.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Conacher ID, Velasquez H, Morrice DJ. Endobronchial tubes – a case for re-evaluation. Anaesthesia. 2006;61:587.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Hannallah MS. The optimal breathing tube for tracheal resection and reconstruction. Anesthesiology. 1995;83:419.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 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.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Sanders RD. Two ventilating attachments for bronchoscopes. Del Med J. 1967;39:170–3.Google Scholar
  29. 29.
    Lee P, English ICW. Management of anesthesia during tracheal resection. Anaesthesia. 1974;29:305.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Ellis RH, Hinds CJ, Gadd LT. Management of anaesthesia during tracheal resection. Anaesthesia. 1976;31:1076.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    McClish A, Deslauriers J, Beaulieu M, et al. High-flow catheter ventilation during major tracheobroncheal reconstruction. J Thorac Cardiovasc Surg. 1985;89:508.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Baraka A. Oxygen-jet ventilation during tracheal reconstruction in patients with tracheal stenosis. Anesth Analg. 1977;56:429.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Clarkson WB, Davies JR. Anaesthesia for carinal resection. Anaesthesia. 1978;33:815.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Carlon GC, Kahn RC, Howland WS, et al. Clinical experience with high frequency ventilation. Crit Care Med. 1981;9:1.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Howland WS, Carlon GC, Goldiner PL, et al. High-frequency jet ventilation during thoracic surgical procedures. Anesthesiology. 1987;67:1009.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Sjostrand U. High-frequency positive-pressure ventilation: a review. Crit Care Med. 1980;8:345.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Glenski JA, Crawford M, Rehder K. High-frequency, small volume ventilation during thoracic surgery. Anesthesiology. 1980;59:577.Google Scholar
  38. 38.
    Carlon GC, Griffin J, Ray C Jr. High-frequency jet ventilation in experimental airway disruption. Crit Care Med. 1983;11:353–5.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Beamer WC, Prough DS, Royster RL, et al. High-frequency jet ventilation produces auto-PEEP. Crit Care Med. 1984;12:734.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Froese AS, Bryan AC. High frequency ventilation. Am Rev Respir Dis. 1987;135:1363.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Magnusson L, Lang FJW, Monnier P, et al. Anaesthesia for tracheal resection: report of 17 cases. Can J Anaesth. 1997;44:1282.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Perera ER, Vidic DM, Zivot J. Carinal resection with two high-frequency jet ventilation delivery systems. Can J Anaesth. 1993;40:59.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Louhimo I, Leijala M. Cardiopulmonary bypass in tracheal surgery in infants and small children. Prog Pediatr Surg. 1987;21:58–63.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Vyas AB, Lyons SM, Dundee JW. Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis. Anaesthesia. 1983;38:132.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Macchiarini P, Rovira I, Ferrarello S. Awake upper airway surgery. Ann Thorac Surg. 2010;89:387–91.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 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.CrossRefGoogle Scholar
  68. 68.
    Hammer GB, Philip BM, Schroeder AR, et al. Prolonged infusion of dexmedetomidine for sedation following tracheal resection. Paediatr Anaesth. 2005;15:616–20.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Lane GA, Steude G, Pashley NRT. Anesthesia for a patient with a tracheal T-tube stent. Anesth Analg. 1981;60:218.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Baraka A, Muallem M, Noueihid R, et al. Oxygen jet ventilation of patients with tracheal T-tube. Anesth Analg. 1982;61:622.PubMedPubMedCentralGoogle Scholar
  72. 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. 73.
    Lang SA, Duncan PG, Shepard DAE, et al. Pulmonary oedema associated with airway obstruction. Can J Anaesth. 1990;37:201.CrossRefGoogle Scholar
  74. 74.
    Koch SM, Abramson DC, Ford M, et al. Bronchoscopic findings in post-obstructive pulmonary oedema. Can J Anaesth. 1996;43:73.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Mussi A, Ambrogi MC, Menconi G, et al. Surgical approaches to membranous tracheal wall lacerations. J Thorac Cardiovasc Surg. 2000;120:115.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Devitt JH, Boulanger BR. Lower airway injuries and anaesthesia. Can J Anaesth. 1996;43:148–59.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Abernathy JH, Reeves ST. Airway catastrophes. Curr Opin Anesthesiol. 2010;23:41–6.CrossRefGoogle Scholar
  78. 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.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Salem MR, Wong AY, Lin YH, et al. Prevention of gastric distension during anesthesia for newborns with tracheoesophageal fistulas. Anesthesiology. 1973;38:82.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Au CL, White SA, Grant RP. A novel intubation technique for tracheoesophageal fistula in adults. Can J Anaesth. 1999;46:688.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Anesthesia and Pain ManagementThe Toronto General Hospital, University Health NetworkTorontoCanada

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