Anaesthetic Management of Acquired Tracheal Stenosis for Tracheal Resection and Reconstruction

Abstract

Tracheal resection is a rare and complex surgery. The critical phases of the surgery are during induction in the presence of a critical airway, intraoperatively during airway transection and postoperatively for the maintenance of the reconstructed airway with planned early extubation to prevent wound dehiscence. An oedematous airway and fixed flexion of the neck are added risks in the postoperative period. We report a case of a 16-year-old boy with tracheal stenosis in the proximal trachea for elective resection and reconstruction. He received intravenous induction with bougie-guided intubation. Intraoperatively, oxygenation was maintained through the transected trachea. As he had an inadequate recovery from anaesthesia at the end of the surgery, he was extubated after few hours of mechanical ventilation and had an unremarkable recovery. A comprehensive planned airway management with anticipation of preoperative airway maintenance and good communication with surgeons are key to the safe management of this complex surgery.