Intraoperative Airway Management Research Articles

Unlocking the Potential of Submental Intubation - Redefining Airway Management in Craniomaxillofacial Trauma Patients

Study Design Submental intubation is and underutilized alternative to traditional techniques of intubation. Complications associated can indeed deter surgeons and anesthesiologist from performing it. Surgeons may opt for submental intubation if they believe that its advantages outweigh the potential risks of the procedure. Identifying the reasons of complications and implementing of proper strategies to address them can help mitigate risks. Objective This study aims to compare and analyze the complications experienced during and after submental intubation to comment on its safety, efficacy. Revisiting literature, will help us to comment on diagnosis in trauma and associated perioperative and intraoperative complication with it. It will also help us deduce most preferred way of performing submental intubation and various methods to manage complications. Methods Submental intubation in patients experiencing craniofacial trauma was reviewed retrospectively for 9 years from January 2015 to August 2023. Common diagnosis sites were analyzed for perioperative and postoperative complications. Results It was found that there were no much complications faced perioperatively and also notes methods used for management of complications. Most commonly encountered postoperative complication was scar. Literature of past years was reviewed, during process we also came out with novel method for safe extubation for which we have got copyright from Government of India. Conclusions Submental intubation is a safe and efficient intraoperative airway management technique for patients with craniomaxillofacial injuries when there is concurrent facial trauma. This study findings would underscore the safety and efficacy of SEI, making it a promising unparalleled method of airway management worth considering.

Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

No consensus exists on the standard of intraoperative airway management approach to prevent endoscopy complications in acute gastrointestinal (GI) bleeding. Eight years after our initial meta-analysis, we reassessed the effect of prophylactic endotracheal intubation in acute GI bleeding in hospitalized patients. Multiple databases were reviewed in 2024, identifying 10 studies that compared prophylactic endotracheal intubation (PEI) versus no intubation in acute upper GI bleeding in hospitalized patients. Outcomes of interest included pneumonia, length of hospital stay, aspiration, and mortality. The odds ratio (OR) or mean difference (MD) using the random effects model was calculated for each outcome. In total, 11 studies (10 retrospective, one prospective) were included in the meta-analysis (n = 7,332). PEI demonstrated statistically significant higher odds of pneumonia (OR = 5.83; 95% confidence interval (CI) = 3.15-10.79; p < 0.01) and longer length of stays (MD = 0.84; 95% CI = 0.12-1.56; p = 0.02). However, mortality (OR = 1.68; 95% CI = 0.78-3.64; p = 0.19) and aspiration (OR = 2.79; 95% CI = 0.89-8.7; p = 0.08) were not statistically significant. PEI before esophagogastroduodenoscopy for hospitalized upper GI bleeding patients is associated with an increased incidence of pneumonia within 48 hours and prolonged hospitalization but no statistically significant increased risk of mortality or aspiration.

Decellularized Wharton's Jelly and Amniotic Membrane Demonstrate Potential Therapeutic Implants in Tracheal Defects in Rabbits.

Tracheal grafts have been investigated for over a century, aiming to replace various lesions. However, tracheal reconstruction surgery remains a challenge, primarily due to anatomical considerations, intraoperative airway management, the technical complexity of reconstruction, and the potential postoperative morbidity and mortality. Due to research development, the amniotic membrane (AM) and Wharton's Jelly (WJ) arise as alternatives within the new set of therapeutic alternatives. These structures hold significant therapeutic potential for tracheal defects. This study analyzed the capacity of tracheal tissue regeneration after 60 days of decellularized WJ and AM implantation in rabbits submitted to conventional tracheostomy. An in vivo experimental study was carried out using thirty rabbits separated into three groups (Control, AM, and WJ) (n = 10). The analyses were performed 60 days after surgery through immunohistochemistry. Different immunomarkers related to scar regeneration, such as aggrecan, TGF-β1, and α-SMA, were analyzed. However, they highlighted no significant difference between the groups. Collagen type I, III, and Aggrecan also showed no significant difference between the groups. Both scaffolds appeared to be excellent frameworks for tissue engineering, presenting biocompatibility and a desirable microenvironment for cell survival; however, they did not display histopathological benefits in trachea tissue regeneration.

Anterior mediastinal masses: A single centre-based retrospective study

Anterior mediastinal masses pose a serious challenge to anaesthetists and surgeons alike. It is sometimes associated with a severe cardiorespiratory compromise during surgery. The aim of this study was to evaluate the incidence of difficulty in airway management, intraoperative cardiorespiratory and postoperative complications in patients undergoing surgery for anterior mediastinal mass excision. We conducted a single centre-based retrospective observational study of the data of patients with anterior mediastinal mass who were treated surgically between February 2016 to January 2021. All the data of the patients were kept confidential. Data were collected from electronic medical records, operation theatre records, anaesthesia charts, intensive care unit (ICU) records, and discharge sheets. Demographic data, medical history, and preoperative imaging investigations were noted. The difficulty in airway management, amount of blood loss, blood transfusion, and other significant events during the intraoperative period were noted. In the postoperative period, the duration of mechanical ventilation, re-exploration, duration of ICU stay, hospital stay, and other complications were recorded. In our study, no patient suffered difficulty in intraoperative airway management(N=29). The intraoperative complication was seen in 13% of cases in the form of significant hemodynamic compromise. No patient underwent re-exploration. The mean blood loss during surgery was 455 ml. The mean duration of postoperative mechanical ventilation was 17 hours, and the ICU stay was 2.3 days. Postoperative complications were seen in 6% of cases (2 patients). Despite best management, some complications may happen in this subset of patients. A comprehensive multidisciplinary approach can minimize the risk of catastrophic hemodynamic and airway compromise during surgical excision.

Airway and anesthesia management in tracheoesophageal fistula closure implantation: a single-centre retrospective study

ObjectiveTo review and analyze the airway and anesthesia management methods for patients who underwent endoscopic closure of tracheoesophageal fistula (TEF) and to summarize the experience of intraoperative airway management.MethodWe searched the anesthesia information system of the First Affiliated Hospital of Nanjing Medical University for anesthesia cases of TEF from July 2020 to July 2023 and obtained a total of 34 anesthesia records for endoscopic TEF occlusion. The intraoperative airway management methods and vital signs were recorded, and the patients’ disease course and follow-up records were analyzed and summarized.ResultsThe airway management strategies used for TEF occlusion patients included nasal catheter oxygen (NCO, n = 5), high-flow nasal cannula oxygen therapy (HFNC, n = 4) and tracheal intubation (TI, n = 25). The patients who underwent tracheal intubation with an inner diameter of 5.5 mm had stable hemodynamics and oxygenation status during surgery, while intravenous anesthesia without intubation could not effectively inhibit the stress response caused by occluder implantation, which could easily cause hemodynamic fluctuations, hypoxemia, and carbon dioxide accumulation. Compared with those in the TI group, the NCO group and the HFNC group had significantly longer surgical times, and the satisfaction score of the endoscopists was significantly lower. In addition, two patients in the NCO group experienced postoperative hypoxemia.ConclusionDuring the anesthesia process for TEF occlusions, a tracheal catheter with an inner diameter of 5.5 mm can provide a safe and effective airway management method.

Endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway.

To evaluate the safety and efficacy of endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway (LMA) approach. The records of all patients who underwent endoscopic surgery for subglottic stenosis (SGS) from November 2019 to January 2023 at an academic medical center were reviewed with attention to demographics, patient comorbidities, airway stenosis characteristics, operative time details, surgical complications, and post-operative course. All patients, >18 years old, with one or more surgeries for SGS using (LMA) for intraoperative airway management were included. Surgeries with suspension microlaryngoscopy were excluded. Patients with glottic stenosis or tracheotomy were excluded. Thirty-five patients underwent 52 procedures meeting inclusion criteria. Mean age was 55 years (range 31-78, SD 13.3) and 33 patients (94%) were female. Mean BMI was 30.9 (range 18.4-60.5, SD 8.8). The most common etiology of stenosis was intubation injury in 17 patients (49%), followed by idiopathic in 13 patients (37%). Cotton-Meyer grade 3 (71-99% narrowing) was seen in 25 patients (71%). Mean anesthesia and surgical operative times were 75.9 min (SD 13.5 min) and 39.7 min (SD 11.0 min), respectively. Mean SpO2 nadir was 94.5% (SD 6.3%). No patients required intraoperative change to rigid laryngoscopy, intubation, or tracheotomy. There were no post-operative complications. Mean surgery-free interval was 12.2 months (SD 6.3). Endoscopic treatment of subglottic stenosis with flexible bronchoscopy and spontaneous ventilation via LMA approach is a safe and effective option, especially in patients with limitations for rigid laryngoscopy and elevated BMI. Level Four (case series) Laryngoscope, 134:2672-2677, 2024.

Laparoscopically assisted percutaneous endoscopic gastrostomy performed for remnant stomach in patient with amyotrophic lateral sclerosis: a case report

BackgroundAlthough percutaneous endoscopic gastrostomy (PEG) offers better access to the gastrointestinal system, in patients with previous abdominal surgery, PEG can be unsuccessful. Laparoscopically assisted percutaneous endoscopic gastrostomy (LAPEG) is indicated for such patients. However, patients with amyotrophic lateral sclerosis (ALS) may be more susceptible to anesthesia-related complications than other patients, requiring the indications for LAPEG, along with perioperative management, to be considered carefully.Case presentationA 70-year-old, male patient with ALS was referred to our hospital for a gastrostomy for progressive dysphagia. He had undergone an open distal gastrectomy for gastric ulcer perforation in his twenties. Upper gastrointestinal endoscopy denied the transillumination sign and focal finger invagination. Because the risk of respiratory complications caused by general anesthesia was not considered serious, the decision was made to perform a LAPEG. Under careful, intraoperative airway management and neuromuscular monitoring, adhesiolysis was performed to increase mobility of the remnant stomach. A gastrostomy tube was inserted through the abdominal wall and into the remnant stomach under laparoscopic and endoscopic guidance. The patient was discharged in stable condition on postoperative day 3 without any respiratory complications.ConclusionsLAPEG was able to be performed in a patient with ALS with a previous gastrectomy. A perioperative team comprised of neurologists, endoscopists, surgeons, anesthesiologists, and nurses who are fully conversant with ALS must be assembled to deal with potentially complex medical issues related to the procedure and anesthetic and perioperative management.

No: 7463 Complex post-COVID consequences: a case report of intra-operative airway management for sub-glottic stenosis dilatation in the context of long-term post-COVID-19 lung damage

No: 7463 Complex post-COVID consequences: a case report of intra-operative airway management for sub-glottic stenosis dilatation in the context of long-term post-COVID-19 lung damage

Observational analysis of criteria for a difficult airway alert

Introduction: Difficult airway alerts are a tool used to document difficulties encountered with the patient’s airway and assist with future management. There is no universally accepted criterion as to who should get a difficult airway alert and the indication for these alerts may be changing with the proliferation of videolaryngoscopes. The purpose of this study was to characterize the airway events that were encountered in patients who had been assigned a difficult airway alert by staff anesthesiologists. Methods: This retrospective study analyzed the airway details of patients who were assigned a difficult airway letter at an academic teaching institution between November 2011 and January 2016. Electronic records of intraoperative airway management and difficult airway letters were reviewed for the methods used, difficulties encountered, and what recommendations were provided for future airway management. Results: A cohort of 107 adult patients (62 males and 45 females) issued difficult airway letters identified for analysis. The mean age (SD) of the cohort was 57 (±13) years, and the mean body mass index was 31 (±7) kg/m2. Direct laryngoscopy failed in 68 of 89 cases, with 77 reported grade III views and 9 grade IV views. Videolaryngoscopy (VL) was used successfully in 63 cases, with 8 documented VL failures. Ten patients were intubated awake with a flexible bronchoscope (FB), and 6 cases were managed using an asleep FB technique. The most common methods suggested for future airway management were VL (57 cases) or either awake or asleep FB (31 cases). Conclusions: Patients with difficult direct laryngoscopy were predominant in this cohort who were assigned a difficult airway alert. Many of the difficult airways were successfully managed using VL, however, FB was required in some cases. Staff preferentially recommended VL over flexible bronchoscopy for future management of the known difficult airway.

Intraoperative airway management for patients with tracheal tumors: A case series of 37 patients.

BackgroundTracheal tumors are rare. The aim of this case series was to investigate airway selection during radical surgery for patients with tracheal tumors.MethodsHere, we performed a retrospective case review of patients with tracheal tumors who underwent tracheal surgery in our center. A total of 37 cases, including 26 patients with primary tracheal tumors and 11 cases with advanced thyroid cancer, were enrolled into the study. Baseline characteristics and differential prognosis of included patients were estimated. We summarize the strategies for intraoperative airway selection and analyze the risk factors associated with delayed extubation.ResultsThere is a trend for primary tracheal tumors to appear toward the upper (9 of 26) and middle third (9 of 26) of the trachea, followed by the lower third airway (8 of 26). Advanced thyroid cancers occur most frequently in the upper trachea (7 of 11) and then the middle trachea (4 of 11). All primary and secondary patients underwent R0 resection. Minor histological subtypes were found to correlate with a poor prognosis. Extracorporeal support and tracheotomy intubation were applied in high‐risk cases, and a total of 32 patients achieved intrathoracic intubation during the surgical process. Intensive care unit (ICU) delay (>1 day) was observed among 25 patients, which were not enriched in cases who underwent cross‐field endotracheal intubation. Additionally, temporal suboptimal oxygenation (SpO2 < 95%) was an independent risk factor of ICU delay.ConclusionsAirway selection plays an important role in successful tracheal surgery, and an appropriate ventilation routine depends on the patient and a surgical process which is safe and effective.

Incidence of Difficult Laryngoscopy in Adult Congenital Heart Disease Patients: A Retrospective Cohort Study

To identify the incidence of difficult intubation in patients with adult congenital heart disease (ACHD) undergoing cardiac surgery or catheterization. A retrospective cohort study. A single-center academic quaternary pediatric hospital. All patients were >18 years of age with ACHD undergoing endotracheal intubation within the Heart Center at Texas Children's Hospital between January 2012 and December 2019. None. A retrospective chart review was performed, including patient demographics, preoperative airway assessment and intraoperative airway management characteristics. Airways were categorized as difficult using the Pediatric Difficult Intubation registry operational definitions. For patients classified as having a difficult airway, the preoperative airway examination findings were recorded in addition to factors associated with difficult airway in the adult. The study authors identified 1,029 patients with ACHD who underwent procedures with anesthesia at their institution and were analyzed for the presence of difficult airway. In total, 878 patients were intubated, with 4.3% (n=38) identified to have difficult airway. The presence of concomitant syndromes was greater in patients with difficult intubations and those who were not intubated compared with those who were not difficult intubations (23.7% and 17.2 v 7.5; p < 0.001), respectively. Most patients did not have typical signs associated with difficult intubation. The study authors identified an incidence of difficult laryngoscopy in their cohort of ACHD patients to be 4.3%. Their incidences of difficult laryngoscopy were fewer than that reported in adult patients with noncongenital heart disease. Most importantly, the risk factors associated with difficult laryngoscopy in the normal adult may be different from those presenting with ACHD, necessitating further investigation.

Airway Management for Endoscopic Laryngotracheal Stenosis Surgery During COVID-19.

The novel coronavirus disease 2019 (COVID-19) pandemic presents unique challenges for surgical management of laryngotracheal stenosis. High viral concentrations in the upper aerodigestive tract, the ability of the virus to be transmitted by asymptomatic carriers and through aerosols, and the need for open airway access during laryngotracheal surgery create a high-risk situation for airway surgeons, anesthesiologists, and operating room personnel. While some surgical cases of laryngotracheal stenosis may be deferred, patients with significant airway obstruction or progressing symptoms often require urgent surgical intervention. We present best practices from our institutional experience for surgical management of laryngotracheal stenosis during this pandemic, including preoperative triage, intraoperative airway management, and personal protective measures.

&lt;p&gt;Submental Intubations in Panfacial Fractures&lt;/p&gt;

IntroductionAirway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management.MethodsThe descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally.ResultsThe submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (±0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (±1.49) days.DiscussionSubmental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.

Watching, Reading and Don’t See-Lung surgery: A Case Report

Incorrect preoperative evaluation can lead to some problems in anesthesiologic management, particularly in thoracic anesthesia. We present the case of an old man with a history of adenocarcinoma of the rectum, diagnosed with a solid pulmonary nodule. The thoracic surgery team scheduled an Uniportal Video-Assisted Thoracoscopy (U-VATS) atypical resection of the right lower lobe. Intraoperative airway management was complicated by the unexpected presence of a tracheal diverticulum, a rare pathological issue that can cause many difficulties in airways management Mastery of the bronchoscopy technique by experienced anesthesiologists and their knowledge of alternative choices for pulmonary exclusion, allowed to choose an alternative for the one lung ventilation, without causing any harm to the patient. Correct handling of the bronchoscope is a gold standard tool for modern anesthesiologist. It is also mandatory, from our point of view, to examine diagnostic images with a critical eye, looking for those details that could make the difference on anesthesiologic management of the patients.

Watching, Reading and Don’t See-Lung surgery: A Case Report

Incorrect preoperative evaluation can lead to some problems in anesthesiologic management, particularly in thoracic anesthesia. We present the case of an old man with a history of adenocarcinoma of the rectum, diagnosed with a solid pulmonary nodule. The thoracic surgery team scheduled an Uniportal Video-Assisted Thoracoscopy (U-VATS) atypical resection of the right lower lobe. Intraoperative airway management was complicated by the unexpected presence of a tracheal diverticulum, a rare pathological issue that can cause many difficulties in airways management Mastery of the bronchoscopy technique by experienced anesthesiologists and their knowledge of alternative choices for pulmonary exclusion, allowed to choose an alternative for the one lung ventilation, without causing any harm to the patient. Correct handling of the bronchoscope is a gold standard tool for modern anesthesiologist. It is also mandatory, from our point of view, to examine diagnostic images with a critical eye, looking for those details that could make the difference on anesthesiologic management of the patients.

Submental Intubation with LMAFastrach&amp;lt;sup&amp;gt;TM&amp;lt;/sup&amp;gt; Endotracheal Tube in Maxillofacial Trauma: A Case Report

Securing a definitive airway in patients who require surgical fixation of complex maxillofacial fractures is an integral part of their perioperative management. For the ease of surgical access, an orotracheal tube is usually not preferred by surgeons. The presence of a base of skull or nasal bone fractures would also contraindicate nasotracheal intubation. Therefore, a tracheostomy may be the only option left to secure the airway in these patients who require surgical fixation. Submental intubation has been used as a safe and effective alternative method in patients who require intubation for maxillofacial reconstruction since it was first reported by Hernandez Altemir F in 1986. Many modifications to the original technique have been documented over the years, but there has been no consensus to support the use of a single method or device. In this case report, we described our experience with submental intubation using an LMAFastrachTM endotracheal tube (ETT) to facilitate the surgical fixation of bilateral Le Fort II fractures. We conclude that the LMAFastrachTM ETT is a suitable device for submental intubation. This technique should be included in airway workshops and courses for anaesthesia residents as it is a simple yet secure alternative to tracheostomy in the intraoperative airway management of maxillofacial trauma.

Perioperative management of the obese ambulatory patient

The prevalence of obesity continues to rise in developed countries. Increasingly, anaesthesiologists are faced with management of this cohort of patient in the ambulatory setting. This review summarizes the factors involved with such management of the obese patient as well as provision of guidance on recently accrued evidence. A number of reviews have emphasized the value of preoperative assessment in ambulatory management for the obese, with emphasis on diagnosis, management and outcomes of patients with obstructive sleep apnoea. Drug delivery particularly with appropriate dose schedules modified to BMI has been refined, whereas the choices of intraoperative airway management have been clarified. Perioperative care of the obese patient is a multidisciplinary team exercise involving staff, equipment and insight into the condition. On the proviso of this insight, there is no reason why ambulatory care cannot be safely provided.

Evaluation of efficacy of Arndt endobronchial blocker for airway management during one-lung ventilation in pediatric patients

Objective To evaluate the efficacy of Arndt endobronchial blocker (AEB) for airway management during one-lung ventilation(OLV) in pediatric patients. Methods Thirty pediatric patients, aged 4 months-12 yr, weighing 5.6-26.0 kg, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, scheduled for elective thoracotomy under OLV requiring the use of single lumen tracheal tube assisted by AEB, were enrolled in this study.OLV was performed with the AEB placed outside the single lumen tracheal tube in pediatric patients below 2 years old and with AEB inserted through the single lumen tracheal tube in pediatric patients ≥ 2 years old.The rate of successful establishment of artificial airway at first attempt, time of establishing artificial airway, time of pulmonary collapse, AEB malpositions and airway pressure before and after OLV were recorded, and the efficacy of lung collapse was evaluated. Results The rate of successful tracheal intubation of extraluminal and endoluminal AEB placement at first attempt was 100% in 30 pediatric patients, and no high airway pressure was found after OLV.The efficacy of lung collapse was poor in one patient and good in one patient, and intraoperative AEB malpositions were found in two patients among the pediatric patients used extraluminal AEB placement.The efficacy of lung collapse was good in one patient, intraoperative AEB malposition was found in one patient, and SpO2 was decreased after OLV in one patient among the pediatric patients used endoluminal AEB placement. Conclusion Reasonably selecting the method of placing AEB followed by enhancing intraoperative airway management can be safely and effectively applied for OLV in pediatric patients. Key words: Intubation, intratracheal; Respiration, artificial; Child

A mouthful - airway matters in intraoperative neuromonitoring in auditory brainstem implant surgery for the pediatric patient: a case series

BackgroundThe Auditory brainstem implant (ABI) is a new surgical option for hearing impaired children. Intraoperative neurophysiology monitoring includes brainstem mapping of cranial nerve (CN) IX, X, XI, XII and their motor nuclei, and corticobulbar tract motor-evoked potential. These require laryngeal electrodes and intra-oral pins, posing a challenge to airway management especially in the pediatric airway, where specialized electromyogram (EMG) tracheal tubes are not available.Challenges include determining the optimum position on the endotracheal tube (ETT) in which to place laryngeal electrode, and the increase in external diameter of ETT contributed by the wrapping the electrode around the shaft of ETT; this may necessitate downsizing of the tracheal tube. An appropriate size ETT minimizes displacement, which in turn can affect electrode contact with the vocal cords. Finally, a small thus crowded pediatric airway makes for difficult visualization during placement of intraoral neuromonitoring electrodes. The use of a videolaryngoscope helps determine optimum electrode placement.Case presentationWe describe intraoperative neurophysiology monitoring and airway management for the first two ABI procedures in Singapore, conducted for children with congenitally absent cochlear nerves.ConclusionNeurophysiology cranial nerve IX, X, XII monitoring in the ABI procedure requires intraoral placement of electrodes. Care should be exercised during placement and removal. Vagus nerve monitoring in children requires attention to tube preparation, and consideration should be given to avoidance of airway topicalization.

State of the art in tracheal surgery: a brief literature review

Background: Tracheal surgery requires a highly specialized team of anesthesiologists, thoracic surgeons, and operative support staff. It remain a formidable challenge for surgeons due to the criticality connected to anatomical considerations, intraoperative airway management, technical complexity of reconstruction, and the potential postoperative morbidity and mortality. Main body: This article focuses on the main technical aspects and literature data regarding laryngotracheal and tracheal resection and reconstruction. Particular attention will be paied to anastomotic and non-anastomotic complications. Short conclusion: Results from literature confirm that, when feasible, laryngotracheal and tracheal resection and reconstruction is the treatment of choice in cases of benign stricture and malign neoplasm. Careful patient selection, operative planning, and execution are required for optimal results.