Surgery on the distal trachea or the carina presents special problems for maintaining the airway and systemic oxygenation. Cardiopulmonary bypass is an alternative method for respiratory support for the patients with these conditions. Percutaneous cardiopulmonary support (PCPS) applied under local anesthesia has recently been used for respiratory support in tracheal surgery and the outcome is satisfactory. We encountered a patient who had severe distal tracheal stenosis after prolonged intubation. We had a gratifying result with performing tracheal resection and repair under the support of PCPS.
Anesthesia, Local ; Cardiopulmonary Bypass ; Humans ; Intubation ; Oxygen ; Trachea ; Tracheal Stenosis

Adolescent ; Anesthesia ; methods ; Female ; Humans ; Intubation, Intratracheal ; Trachea ; surgery ; Tracheal Neoplasms ; surgery

The management of airway during anesthesia is mandatory but it is very difficult in certain diseases, especially when a tracheoplasty and bronchoplasty is done. Tracheal stenosis is caused by congenital factors, trauma, physical compression, infection, intrabronchIal granuloma, tumor etc. Among those causes, congenital tracheobronchial stenosis is very rare and it accompanies pulmonary arterial sling and cardiovascular anomaly. Our anesthetic experience of succesful tracheal management during tracheobronchoplasty (3 times), bronchoscopic examination and bougienation (7 times), insertion of a single stent (1 time) and double stents into the trachea and the main bronchus (2 times) on a child who has a congenital complete circular tracheal cartilage and pulmonary arterial sling which caused tracheal stenosis will be reported, along with a literature review.
Anesthesia ; Bronchi ; Cartilage ; Child ; Constriction, Pathologic ; Granuloma ; Humans ; Infant* ; Stents ; Trachea ; Tracheal Stenosis

Tracheotomy and end-to-end anastomosis is a relatively rare operation, but it is one of the most challenging for anesthesiologists. During surgery, the principal anesthetic consideration is to maintain the ventilation and oxygenation throughout the procedure. We experienced anesthetic management of a 49-year-old man with upper tracheal stenosis after long-term intubation and ventilation care. The stenotic lesion was located at 2 cm below the vocal cords, and the length of the stenotic segment was about 2 cm. The anesthesia was induced and maintained with intravenous propofol and alfentanil. The airway was managed with LMA and distal tracheal intubation on the surgical field and we were able to maintain adequate ventilation and oxygenation throughout the operational period.
Alfentanil ; Anesthesia ; Humans ; Intubation ; Laryngeal Masks* ; Middle Aged ; Oxygen ; Propofol ; Tracheal Stenosis* ; Tracheotomy* ; Ventilation ; Vocal Cords

The Montgomery T-tube poses a challenge to anesthesiologists because of loss of anesthetic gases through the open proximal end of the vertical limb and lack of standard anesthesia circuit connectors. Here, we present a case of a 25-year-old woman with a reported history of accidental strangulation 18 months previously. The patient had a metallic tracheostomy tube in situ due to the development of tracheal stenosis. Computed tomography showed significant narrowing in a 7–8-mm segment, 2 cm proximal to the tracheostomy tube in situ. She was scheduled for tracheal reconstruction surgery and T-tube insertion due to persistent subglottic stenosis. In this case, the Foley's catheter, which was inserted into the glottis orally, not only aided easy insertion of the T-tube into the trachea through the tracheal stoma, but also enabled us to stop the loss of anesthetic gases through the proximal vertical limb of the T-tube.
Adult ; Anesthesia ; Anesthetics, Inhalation ; Catheters* ; Constriction, Pathologic ; Extremities ; Female ; Glottis ; Humans ; Trachea ; Tracheal Stenosis ; Tracheostomy

Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circulation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anesthetic management. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.
Adult ; Anesthesia, General ; methods ; Emergencies ; Extracorporeal Circulation ; Humans ; Male ; Pulmonary Gas Exchange ; Tracheal Stenosis ; surgery

BACKGROUND: This study compared the onset of action of Rocuronium given as single bolus versus divided dosing, using Propofol as an induction agent. The intubating conditions and hemodynamic changes accompanying laryngoscopy and tracheal intubation were assessed following the induction techniques. METHODS: Forty ASA I and II patients who underwent elective surgical procedures under general endotracheal anesthesia, aged 15 to 65 years old and categorized under Mallampati classifications I and II were included. They were randomly assigned to two groups. For Group A intubation sequence was Rocuronium 0.6 mg./kg., Propofol 2 mgs./kg., then 5 m1s. of plain isotonic solution. Group B sequence was: Rocuronium 0.4 mg./kg., Propofol 2 mgs./kg., then Rocuronium 0.2 mg./kg. Single twitch stimulation and train-of-four were used to monitor the onset time and intubation time. Statistical analysis was done by descriptive statistics and paired students T-test with a P-value0.05 considered significant RESULTS: Onset time and intubation time for the group given a divide dose of Rocuronium were shorter. No significant change in mean arterial pressures was seen in both groups, although there was an increase in cardiac rate for the group given a single bolus. CONCLUSION: The combination of Propofol and Rocuronium in divided dose is ideal for rapid sequence intubation.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; HEMODYNAMICS ; LARYNGOSCOPY ; INTUBATION ; TRACHEAL, ANESTHESIA ; ROCURONIUM ; PROPOFOL

The objective of this case report is to present the anesthetic concerns as well as the primary and alternate management strategies in a patient with cervical spine injury.
Human ; Female ; Adult ; INJURY ; CERVICAL SPINE ; ANESTHESIA ; PAIN ; CERVICAL LARYNGOSCOPY ; INTUBATION, TRACHEAL

As 8 year old boy with a tracheal cannula because of tracheal stenosia was admitted for tracheal raconstruction. The tracheal stenosis site was 2cm below the tracheal soma and 4cm above the carina. The stenotic area was 5mm in diameter and 1.5cm in length. After proper premedication, anesthesia was induced with intramuscular ketamine and maintained mainly with 0.1% ketamine intravenous drip infusion and supplemented by small amounts of muscle relaxants and N2O EKG, direct arterial pressure and arterial blood gas tensions were monitored during anesthesia. Tracheal segmental resection and reconstruction were performed without serious hypoxia and hypercarbia. Anesthetic management for possible risk during operation was discussed and the literature reviewed.
Anesthesia* ; Anoxia ; Arterial Pressure ; Carisoprodol ; Catheterization* ; Catheters ; Child* ; Electrocardiography ; Humans ; Infusions, Intravenous ; Ketamine ; Male ; Premedication ; Tracheal Stenosis*

Due to the increased use of tracheostomy and intermittent positive pressure ventilation, patients with trscheal stenosis have become more frequent. Recently we experienced a patient with tracheal stenosis who was tracheostomized upon admission, but unfortunately the stenotic lesion was located below the end of the tracheostomy tube. The stenotic lesion was l.6cm above the carina, its diameter was 0.5 cm, and the length of the stenotic segment was about 2cm, A3,5 mm(I.D.) endotracheal tube was passed through the stenotic lesion via the tracheostomy site, and high frequency jet ventilation was applied with a swivel connector. Immediately after the start of surgery, CO2retention occurred and the driving gas pressure increased from 4p to 5p psi, the I:E ratio from 1:2 to 1: 3, but the respiration rate (100 bpm) was maintained as before. CO2retention was relieved soon. Following end to end anastomosis a 6. 0 mm(I.D.) cuffed endotracheal tube was intubated orally and inhalation anesthesia using N2O-O2-Halothane was maintained until the surgery was completed.
Anesthesia, Inhalation ; Constriction, Pathologic ; High-Frequency Jet Ventilation ; Humans ; Intermittent Positive-Pressure Ventilation ; Respiratory Rate ; Tracheal Stenosis* ; Tracheostomy