SECURITY AND FEASIBILITY STUDY OF AWAKE AIRWAY SURGICAL PROCEDURES

Abstract

TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: The objective is to show the secure and feasibility of local and regional management under awake anesthesia and spontaneous respiration in different airway pathologies to get a diagnosis and relieve in some cases of life-threatening disease. METHODS: Prospective clinical feasibility study for patients with upper tracheal pathology were managed with local anesthetics like spray lidocaine 10% and neural blockade by topicalization. Alternatively, we use 10 ml syringe with lidocaine 2% (n=3). All patients were taken to the operating room as an emergency procedure. The principal biochemical aspect for the emergency was CO2 retention. RESULTS: Thirty-three consecutive patients admitted to the emergency room with tracheal stenosis (n=18), laryngeal and tracheal tumors (n=7), fixed tracheostomy cannula with granuloma (n = 5), obstruction with foreign body (n=2) and tracheitis (n=1) were enrolled. There were 9 women (27.3%) and 24 men (72.7%), with mean age range from 33 to 67 years old. The time of the anesthetic procedure was average 5 minutes, with no complications and a safe management. Operations included pneumatic sequential dilatation, emergency tracheostomy, tracheoplasty and tracheal biopsy. CONCLUSIONS: Our work demonstrates the complete safety of the protocol with adequate local anesthesia that allows to perform procedures in different pathologies of the airway keeping the patient secure, awake and in most of the cases ensuring an ambulatory management. CLINICAL IMPLICATIONS: In high-risk patients where oral intubation can be difficult, impossible and is not an option because of the risk to collapse due to the airway pathology, an alternative is an awake and tubeless upper airway surgery. DISCLOSURE: Nothing to declare. KEYWORD: tracheal surgery