Adult ; Aged ; Esophageal Stenosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nickel ; Stents ; Titanium ; Tracheal Stenosis ; surgery

Adult ; Humans ; Laryngostenosis ; surgery ; Larynx ; injuries ; Male ; Trachea ; injuries ; Tracheal Stenosis ; surgery ; Wounds and Injuries ; surgery

OBJECTIVETo review the methods involved in airway management of tracheal surgery and to consider the role of extracorporeal circulation.

METHODSA total of 91 tracheal surgeries were performed from January 2008 to February 2012, including 60 cases of tumor, 8 cases of post-traumatic stenosis and 23 cases of post-tracheostomy stenosis. There were 76 male and 15 female patients, aged from 4 to 77 years. Anesthetic plans were made according to the severity and position of stenosis. Rapid sequent induction intubations were conducted on 56 patients, tracheostomy intubations on 25 patients, awake intubations on 3 patients, extracorporeal circulation on 6 patients and emergent sternotmy and tracheostomy on 1 patient. Miniature extracorporeal circulation systems were used in all extracorporeal circulation case.

RESULTSAll patients discharged without major complications. There were 2 cases of massive bleeding during operations, 1 case of post-operative tracheal fistula and 1 case of post-operative incision infection. All these 4 cases were treated properly and got cured. One patient on whom extracorporeal circulation was unable to set up underwent 6 minutes of hypoxia before sterotomy and tracheostomy. All the extracorporeal circulation cases were hemodynamically stable during bypass and none of them need massive transfusion. The miniature extracorporeal circulation system was convenient to use and especially suitable for tracheal surgery.

CONCLUSIONSVarious advanced anesthesia techniques can ensure a safe airway for most tracheal surgeries. However, extracorporeal circulation plays a major role in high risk cases. It is important to set up a miniature extracorporeal circulation circuit that is especially suitable for tracheal surgery.

Airway Management ; Extracorporeal Circulation ; Humans ; Trachea ; surgery ; Tracheal Stenosis ; surgery ; Tracheostomy

BACKGROUNDVascular rings are uncommon anomalies in which preferred strategies for diagnosis and management may vary among institutions. In this study, we reported our approach and a review of our 5-year experience.

METHODSFrom May 2006 to April 2011, 45 children (31 boys) with vascular rings underwent surgical repair at Beijing Children's Hospital. Nineteen patients (26%) had associated heart anomalies.

RESULTSThere were two hospital deaths. At follow-up, 11 patients still had intermittent respiratory symptoms, but these symptoms had no effect on growth or physical activities. No patients required reoperation.

CONCLUSIONSThe rates of misdiagnosis and missed diagnosis of vascular rings are higher than those of other congenital heart diseases. A high index of clinical suspicion coupled with the use of computed tomography enables early diagnosis. Surgical repair can be performed successfully, although a number of patients will have persistent symptoms.

Child, Preschool ; Female ; Humans ; Infant ; Male ; Tracheal Stenosis ; mortality ; surgery ; Vascular Malformations ; diagnosis ; mortality ; surgery

OBJECTIVES: To study the role of bronchoscopy in slide tracheoplasty. METHODS: A retrospective analysis was conducted on the diagnosis and treatment of four children with tracheal stenosis admitted to Hunan Provincial People's Hospital from 2017 to 2020. The role of bronchoscopy was summarized in the preoperative evaluation, intraoperative positioning and measurement, and postoperative wound evaluation and treatment during slide tracheoplasty. RESULTS: Bronchoscopy evaluation before slide tracheoplasty showed that 3 of the 4 children had complete trachea rings, 2 had pulmonary artery sling, and 2 had multiple stenosis. Slide tracheoplasty was performed in the hospital on 3 children, and the midpoint of the stenosis segment was judged under bronchoscopy, and the length of the stenosis segment was measured, which assisted in the resection of the stenosis segment of the trachea. The pathogens were identified by lavage after the surgery. One child who developed scar traction 9 months after slide tracheoplasty in another hospital was improved by interventional treatment under bronchoscopy. Mucosal changes were found under bronchoscopy in 2 children 4 days after surgery, and the treatment plan was adjusted. One month after surgery, 2 children had granulation hyperplasia, which was improved by cryotherapy under bronchoscopy. One child abandoned treatment due to anastomotic necrosis and died. Three survivors were followed up for over 6 months with good prognosis, but all had tracheobronchial malacia. CONCLUSIONS Bronchoscopy can be used for the management of slide tracheoplasty in children with tracheal stenosis, which is helpful to postoperative rehabilitation and follow-up.
Child ; Humans ; Bronchoscopy ; Constriction, Pathologic ; Retrospective Studies ; Trachea/surgery* ; Tracheal Stenosis/surgery* ; Treatment Outcome

Adult ; Female ; Granuloma ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Tracheal Diseases ; etiology ; surgery ; Tracheal Stenosis ; etiology ; surgery ; Tracheostomy ; adverse effects

Adult ; Aged ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Tracheal Stenosis ; surgery ; Tracheotomy ; methods ; Young Adult

OBJECTIVETo investigate the efficacy of suspension laryngoscopic surgery for benign laryngotracheal stenosis (LTS).

METHODSThirty-two patients (aged from 5 to 70 years with a median of 36 years) with benign LTS were studied retrospectively who were treated by suspension laryngoscopic surgery with or without assistance of CO₂ Laser for LTS. Stents were placed in 17 cases. Among 32 patients, 13 cases were with LST in Cotton I, 8 cases in Cotton II, and 11 cases in Cotton III; 23 were with single level narrow, and 9 cases with multi-level narrow; the average narrow length was 1.3 cm and the average diameter at maximum stenosis was 0.5 cm; and 19 cases underwent tracheostomy before surgery.

RESULTSFollow-up period ranged from 1 to 18 years with median time of 10 years. Twenty-six patients (81.2%) were successfully decannulated with good airway patency and effective phonation. Six cases failed and 1 case of them was changed to open surgery. Among 17 cases with stent placement, 4 cases were applied additionally with T tube (effective rate of 50.0%), 1 case with laryngeal keel, 12 cases with stents alone (effective rate of 66.7%). Stent-related complications occurred in 2 cases. Patients with cotton I-II had a successful rate of 100% (21/21), while patients with Cotton III showed poor effectiveness (5/11), with a statistical significant difference between two groups (χ² = 14.098, P = 0.001). The patients with single level LTS were successfully treated by suspension laryngoscopic surgery with 100% successful rate (23/23), while the patients with multi-level LTS showed poor effectiveness (3/9), with a statistical significant difference between two groups (χ² = 18.872, P = 0.000) .

CONCLUSIONSSuspension laryngoscopic microsurgery can treat single level LTS with good results and also can be used as a pre-surgery in treatment of multi-level LTS with the virtue of minimal trauma and short recovery time. Application of stents can be helpful for suspension laryngoscope surgery for LST.

Constriction, Pathologic ; Humans ; Laryngoscopy ; methods ; Lasers, Gas ; Microsurgery ; Retrospective Studies ; Stents ; Tracheal Stenosis ; surgery ; Tracheostomy

In thoracic surgery, functional isolation of the lungs can be accomplished by several methods. However, for patients with tracheal stenosis, only limited choices are available to achieve one-lung ventilation (OLV) because of the difficulties posed by the stenotic trachea. In our patient, the narrowest site in the trachea was as small as 9.3 mm in diameter, and therefore a 28 Fr double-lumen endotracheal tube (DLT) or a Univent tube (inner diameter [ID] 6.0 mm) could not be inserted into the trachea. Recently, 7 and 9 Fr Arndt endobronchial blockers (AEB) used in adults could not even be used in our patient. Here we report a case of successful OLV that was performed using a pediatric wire-guided AEB and a small diameter single lumen endotracheal tube (SLT). We believe that this pediatric AEB is a safer and more effective option for achieving OLV in adult patients with tracheal stenosis.
Adult ; Humans ; Lung ; One-Lung Ventilation ; Thoracic Surgery ; Trachea ; Tracheal Stenosis

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