Apnoeic oxygenation with high‐flow oxygen for tracheal resection and reconstruction

Abstract

Objective: This study aimed to evaluate the effectiveness of high‐flow oxygen as the sole method of gas exchange in apnoeic conditions during anastomosis construction. Subject and method: Between April 2019 and August 2020, 16 patients with tracheal stenosis, ages ranging from 19 to 70, underwent tracheal resection and reconstruction. Patients received total anesthesia and neuromuscular blocking agents for the duration of their surgery. During the anastomosis phase using high flow oxygen of 35 - 40 l.min‐1 delivered across an open tracheal with an endotracheal tube (ETT) at the glottis in apnoeic conditions. Result: The mean (SD) apnoea time was 20.91 ± 2.53 mins. Mean (SD) time anastomosis was 22.9 ± 2.41 mins. The saturation of oxygen was stable during all procedures at 98-100%. One patient experienced an oxygen desaturation episode to a value between 88% and 90% lasting less than 2 mins. Arterial blood gas analysis showed that there was hypercapnia and acidosis acute respiratory with pH 7.25 ± 0.04; PaCO2 67.57 ± 14.71mmHg, and PaO2 167.12 ± 76.23mmHg after 10 mins of apnoea and pH was 7.17 ± 0.05; PaCO2 79.63 ± 13.39mmHg and PaO2 186.19 ± 60.14mmHg after 20 mins apnoea, respectively. However, after 15 mins of ventilation, the parameters are ultimately returned to normal. The blood pressure and heart rate are stable at times. All 16 patients were extubated early and safely at the end of the operation. There were no complications, such as bleeding, hemothorax, pneumothorax, or barotrauma. Conclusion: High-flow oxygen across an open tracheal under apnoeic conditions can provide a satisfactory gas exchange to allow tubeless anesthesia for tracheal resection and reconstruction. The surgical field is ultimately in spacious, optimal conditions for anastomosis.