SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anest...SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anesthesiologist. Life-threa- tening airway obstruction can make the patient＇s gas ex- change extremely difficult. Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis.1 Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists.展开更多
BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of...BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.展开更多
Primary tracheal tumors comprise a rare group of benign and malignant tumors of the trachea. Since they cause progressive airway obstruction, no matter benign or malignant, they are life-threatening if not properly tr...Primary tracheal tumors comprise a rare group of benign and malignant tumors of the trachea. Since they cause progressive airway obstruction, no matter benign or malignant, they are life-threatening if not properly treated. Tracheal surgery is the most effective treatmentand has produced a decent resectability rates for tracheal tumors varying from 63% to 90%. The procedure for tracheal tumors usually includes two key steps, tracheal resection and airway reconstruction, which generate not just challenges for thoracic surgeons but particularly for anesthesiologists. We report a successful case of peri-anesthesia management for the tracheal surgery.展开更多
文摘SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anesthesiologist. Life-threa- tening airway obstruction can make the patient＇s gas ex- change extremely difficult. Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis.1 Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists.
文摘BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.
文摘Primary tracheal tumors comprise a rare group of benign and malignant tumors of the trachea. Since they cause progressive airway obstruction, no matter benign or malignant, they are life-threatening if not properly treated. Tracheal surgery is the most effective treatmentand has produced a decent resectability rates for tracheal tumors varying from 63% to 90%. The procedure for tracheal tumors usually includes two key steps, tracheal resection and airway reconstruction, which generate not just challenges for thoracic surgeons but particularly for anesthesiologists. We report a successful case of peri-anesthesia management for the tracheal surgery.
