Currently, enhanced recovery after surgery (ERAS) has been widely accepted by surgery and anesthesiology all over the world, and applied in colorectal surgery, gynecology, liver surgery, breast surgery, urology and spinal surgery. But ERAS are rarely used in the field of interventional bronchoscopy. In recent years, more and more researchers have begun to explore the application of ERAS in bronchoscopic interventional therapy. This article discussed that preoperative preparation, anesthesia, intraoperative operation, postoperative observation and other aspects can influence interventional bronchoscopy.
.
Anesthesia ; methods ; Bronchoscopy ; methods ; Humans ; Length of Stay ; Outcome Assessment (Health Care) ; Perioperative Care ; methods ; Recovery of Function ; Tracheal Neoplasms ; physiopathology ; surgery ; Tracheotomy ; methods

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

We report on a case of difficult endotracheal intubation in a patient with marked tracheal deviation at an angle of 90 degrees combined with stenosis due to kyphoscoliosis with vertebral body fusion. After induction of general anesthesia, a proper laryngeal view was easily obtained using a videolaryngoscope. But a tracheal tube could not be advanced more than 3 cm beyond the vocal cords due to resistance, despite various attempts, including the use of small size tubes, full rotation of the tube tip, and fiberoptic bronchoscopy. Ultimately, the airway was successfully secured by placing a tube tip above the area of resistance and by additionally packing saline-soaked gauzes around the tracheal inlet to minimize gas leakage and to fasten the tube in the trachea.
Anesthesia, General ; Bays ; Bronchoscopy ; Constriction, Pathologic* ; Humans ; Intubation ; Intubation, Intratracheal* ; Kyphosis ; Scoliosis ; Trachea ; Tracheal Diseases ; Vocal Cords

OBJECTIVETo summarize our experiences in anesthetic management for the resection of tracheal masses.

METHODSThe clinical data of 15 patients with tracheal masses in Peking Union Medical College Hospital from 2002 to 2012 were analyzed retrospectively. Remarkable dyspnea and tracheal stenosis were observed in 12 patients. Standard orotracheal intubation was carried out in patients with less than 50% of tracheal lumen obstructed. The location of masses was critical for those with severe tracheal stenosis. Local anesthetics were applied and tracheostomy were performed in patients with masses located at the upper part of the trachea. Intubation above the masses was established in patients with masses located at the lower part of the trachea. Percutaneous cardiopulmonary support was introduced before anesthetic induction in a patient with severe respiratory distress and hypercapnea,then an endotracheal tube successfully passed the stenosis guided by a fiberoptic bronchoscope. General anesthesia was induced intravenously and muscle relaxants were applied in all patients. Succinylcholine was administrated in 5 of 6 difficult patients.

RESULTSAirway management and anesthesia were performed successfully in all the 15 patients. After the operations,patients were extubated and discharged from the hospital without difficulty in respiration.

CONCLUSIONSThe successful airway management of tracheal masses depends on the degree and location of stenosis and the severity of dyspnea. Extracorporeal circulation is an optimal choice for those with critical airway occlusion and adequate oxygenation can not be accomplished with conventional anesthesia.

Adolescent ; Adult ; Aged ; Airway Management ; methods ; Anesthesia ; Extracorporeal Circulation ; Female ; Humans ; Intubation, Intratracheal ; Male ; Middle Aged ; Retrospective Studies ; Tracheal Stenosis ; surgery ; Tracheostomy ; Young Adult

Relapsing polychondritis is a rare disease characterized by progressive inflammation and destruction of cartilaginous structures such as ears, nose, and tracheolaryngeal structures. As a result, tracheolaryngeal involvement makes anesthetic management a challenge. Anesthetic management of a patient with relapsing polychondritis may encounter airway problems caused by severe tracheal stenosis. We present the case of a 60-year-old woman with relapsing polychondritis who underwent wedge resection of the stomach under epidural analgesia. Thoracic epidural blockade of the T4-10 dermatome was achieved by epidural injection of 7 ml of 0.75% ropivacaine and 50 microg of fentanyl. The patient was tolerable during the operation. We suggest that epidural analgesia may be an alternative to general anesthesia for patients with relapsing polychondritis undergoing upper abdominal surgery.
Amides ; Analgesia, Epidural ; Anesthesia, General ; Ear ; Female ; Fentanyl ; Humans ; Inflammation ; Injections, Epidural ; Middle Aged ; Nose ; Polychondritis, Relapsing ; Rare Diseases ; Stomach ; Tracheal Stenosis

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

The Montgomery tracheal tube (T-tube) is a device used as a combined tracheal stent and airway after laryngotracheoplasty for patients with tracheal stenosis. This device can present various challenges to anesthesiologists during its placement, including the potential for acute loss of the airway, inadequate administration of inhalation agents, and inadequacy of controlled mechanical ventilation. The present case of successful airway management used a laryngeal mask airway under total intravenous anesthesia with propofol and remifentanil in the insertion of a Montgomery T-tube in a tracheal resection and thyrotracheal anastomosis because of severe subglottic stenosis.
Airway Management ; Anesthesia, Intravenous ; Constriction, Pathologic ; Humans ; Inhalation ; Laryngeal Masks ; Piperidines ; Propofol ; Respiration, Artificial ; Stents ; Tracheal Stenosis

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

A 76-year-old woman presented with tracheal stenosis caused by a thyroid mass. Her symptoms included dyspnea and wheezing. Cervical computed tomography scans revealed an 8.5 x 7.8 cm sized mass and a trachea with an internal lumen 4.3 mm in diameter. The mass caused marked stenosis and deviation of the airway. However, it was not clear if the tracheal lumen was invaded by the mass. We predicted that airway management would be problematic, even in the absence of invasion. Options for intubation included small sized endotracheal tube, fiberoptic bronchoscopy-guided intubation, high frequency jet ventilation, and percutaneous cardiopulmonary support (PCPS). We decided to use PCPS to reduce the chance of ineffective oxygenation and related complications. After supplementing PCPS with epidural anesthesia, general anesthesia was performed without complications. The patient underwent surgical removal of the mass. PCPS was discontinued on the day of surgery, and after two weeks of uncomplicated mechanical ventilatory support, the patient was discharged home.
Aged ; Airway Management ; Anesthesia, Epidural ; Anesthesia, General ; Constriction, Pathologic ; Dyspnea ; Female ; High-Frequency Jet Ventilation ; Humans ; Intubation ; Oxygen ; Respiratory Sounds ; Thyroid Gland ; 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