Cardiopulmonary Bypass for Tracheal Resection and Repair—A Safe Alternative

Akshay Chauhan,Saket Agarwal,Vishnu Dutt,Satish Kumar Aggarwal,M A Geelani

doi:10.4236/wjcs.2018.811019

Abstract

Airway management during tracheal surgery is always challenging for the anaesthesia team. Cardiopulmonary bypass (CPB) is generally not required during tracheal surgery on the cervical trachea. However, for tracheal surgeries CPB may be advantageous and give the surgeon more freedom to work. We report three cases of post-intubation tracheal stenosis successfully managed with tracheal resection and reconstruction performed under cardiopulmonary bypass.

Highlights

Ill patients are frequently managed with endotracheal intubation and prolonged ventilation
Airway management during tracheal surgery is always challenging for the anaesthesia team
We report three cases of post-intubation tracheal stenosis successfully managed with tracheal resection and reconstruction performed under cardiopulmonary bypass

Summary

Introduction

Ill patients are frequently managed with endotracheal intubation and prolonged ventilation. Design of low pressure high volume cuff in endotracheal/tracheostomy tubes has significantly reduced the incidence of post-intubation tracheal stenosis, it still remains a matter of concern. Though most develop stenosis after prolonged periods of intubation, it can occur after as short a period as 48 hours of intubation [1]. Tracheostomy done for prolonged ventilation can lead to similar devastating outcomes. Symptoms can occur abruptly or gradually, depending upon the pathology, severity and location of the lesion. Management usually involves resection of the diseased tracheal segment with end to end anastomosis. During tracheal resection and reconstruction for tracheal stenosis cardiopulmonary bypass is usually not used.

Case 1

Case 2

Case 3

Discussion

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Conclusion