Airway management in tracheal resection for postintubation stenotic lesions

Abstract

Introduction: Clinical situations and anatomic variants in tracheal stenosis (TS) are quite various so different approaches for artificial lung ventilation (ALV) during tracheal resection are required. The choice of the method of ALV depends on the extent of the lesion, the width of the lumen of the stenotic area, the presence of tracheostomy, and the stage of the operation. Aims: The aim of the study is to elaborate tactics of ALV which should provide good conditions for the surgeon as well as proper gas exchange at every stage of the operation. Methods: The tactics of ALV was developed during circular resection of the trachea in 52 patients with TS located in cervical part of the trachea. Orotracheal tube was inserted in any case. At the stage of trachea dissection and preparation for resection convective mandatory ventilation (CMV) was conducted when the orotracheal tube could be passed distal to the lesion. If the diameter of the stenotic area was too small the catheter was passed from the tube via the stenosis, and high frequency jet ventilation (HFJV) was conducted. The regimen of HFJV was selected to prevent barotrauma and hypoxemia. In the presence of tracheostoma CMV was conducted via the stoma. At the stage of anastomosis suturing the HFJV regimen was continued via the cateter. After the anastomosis completion the tube was passed to the distal trachea, and CMV was continued. Results: No complications occurred during the operation. A proper gas exchange was provided. Conclusions: The combination of CMV and HFJV provided proper conditions for surgical manipulation and adequate gas exchange at any stage of tracheal resection irrespectively of the duration of open airways period.