Cervical tracheal resection without intubation

Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis tracheal resection without using an endotracheal tube. Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis. Results. The resection length ranged from 15 to 45 mm (on average, 273 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 1099 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 122 days). No restenosis was detected at long term follow-up. Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.

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Anesthesia for resection of the trachea without its intubation

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2020-16-1-37-45 ◽

2020 ◽

Vol 16 (1) ◽

pp. 37-45

Author(s):

M. G. Kovalev ◽

A. L. Akopov ◽

Yu. S. Polushin ◽

A. N. Geroeva ◽

V. O. Krivov ◽

...

Keyword(s):

Tracheal Stenosis ◽

Airway Device ◽

Supraglottic Airway ◽

High Frequency Ventilation ◽

Metal Stents ◽

Tracheal Resection ◽

Supraglottic Airway Device ◽

Jet Ventilation ◽

Minimum Diameter ◽

Duration Of Surgery

Introduction. Currently, there is a tendency for a number of post-intubation patients to develop post-tracheostomic cicatricial stenosis of the trachea. This dictates a need for the improvement of surgical and anaesthesiologic approaches to intubation management. Objective: Analysis of the speciﬁc parameters of anesthesia for cervical tracheal resection in patients with stenosis of the trachea without its intubation.Subjects and methods. We analyzed 12 cases of circular resection of the trachea due to benign stenosis. The degree of anesthetic risk was as follows: 11 patients – ASA 3, 1 patient – ASA 4. Tracheal stenosis persisted for 14±6 months before it was resected (Me 4, Min 1, Max 67). The length of the resected part of the trachea was 27±3 mm (Me 25, Min 15, Max 40), duration of surgery – 159±9 min (Me 160, Min 65, Max 240). The anesthesia strategy included the insertion of the I-Gel supraglottic airway device with a jet ventilation catheter put through the I-Gel. Temporary stenting of the stenosis zone of the trachea before surgery (if necessary) instead of bougienate was an important component of the anesthesia strategy. Mandatory use of sedation (dexmedetomidine) is suggested before and within 12 hours after surgery.Results. This strategy can be successfully implemented if the minimum diameter of the tracheal stenosis exceeds 7 mm (the jet ventilation catheter is necessary to be applied through this lumen and a ﬁne bronchoscope used to monitor the state of the catheter tip). Preliminary stenting with metal stents was performed in 5 patients. The I-Gel lumen was wide enough to manipulate a ﬂexible endoscope, a catheter guide was inserted for jet ventilation, and then the catheter itself was placed. The use of high-frequency ventilation mask it advisable to ensure adequate gas exchange at all stages of the surgery. Sedation with dexmedetomidine reduced the patient’s discomfort after the surgery due to the ﬁxation of the patient’s head with stitches in a “nodding” position, which reduced anastomosis tension. In all 12 patients, this anesthesia strategy was successful and provided a more favorable environment for surgeons compared to the classical approach with the use of an endotracheal tube. In all patients, anastomosis healed by primary tension with no complications.Conclusion. The use of a supraglottic airway device, dexmedetomidine, and temporary stenting of the stenotic part of the trachea allow the surgeon to avoid tracheal intubation during circular resection and expand the range of anesthesiological tools during tracheal surgery.

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The Effects of Endotracheal Tube and i-gel® Supraglottic Airway Device on Respiratory Impedance: A Prospective Observational Study

Anesthesiology and Pain Medicine ◽

10.5812/aapm.42964 ◽

2016 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Shoko Nakano ◽

Junko Nakahira ◽

Yosuke Kuzukawa ◽

Toshiyuki Sawai ◽

Toshiaki Minami

Keyword(s):

Observational Study ◽

Endotracheal Tube ◽

Prospective Observational Study ◽

Airway Device ◽

Supraglottic Airway ◽

Respiratory Impedance ◽

Supraglottic Airway Device

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Intubating Through Supraglottic Airway Devices: A Narrative Review

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113719 ◽

2021 ◽

Vol 11 (3) ◽

Author(s):

Say Yang Ong ◽

Vanessa Moll ◽

Berthold Moser ◽

Amit Prabhakar ◽

Elyse M. Cornett ◽

...

Keyword(s):

Tracheal Intubation ◽

Endotracheal Tube ◽

Airway Device ◽

Narrative Review ◽

Supraglottic Airway ◽

Successful Intubation ◽

Success Rates ◽

Supraglottic Airway Device ◽

Supraglottic Airway Devices ◽

Consistent Performance

Implication Statement: Despite the increasing popularity of video laryngoscopes, the supraglottic airway device (SAD) remains a critical airway rescue tool. The SAD provides a conduit for tracheal intubation in failed laryngoscopy. This article aims to help the operator: (1) select an intubating SAD with consistent performance; (2) inform the appropriate SAD-endotracheal tube pairings; and (3) explain various SAD and endotracheal tube maneuvers available to increase chances of successful intubation. Objectives: The first supraglottic airway device (SAD) was introduced more than thirty years ago. Since then, SADs have undergone multiple iterations and improvements. The SAD remains an airway rescue device for ventilation and an intubation conduit on difficult airway algorithms. Data Sources: Several SADs are specifically designed to facilitate tracheal intubation, i.e., “intubating SADs,” while most are “non-intubating SADs.” The two most commonly reported tracheal intubation methods via the SADs are the blind and visualized passage of the endotracheal tube (ETT) preloaded on a fiberoptic scope. Fiberoptic guided tracheal intubation (FOI) via an intubating SAD generally has higher success rates than blind intubations and is thus preferred. However, fiberscopes might not always be readily available, and anesthesiologists should be skilled to successfully intubate blindly through a SAD. Summery: This narrative review describes intubating SAD with consistent performance, appropriate SAD-ETT pairings, and various SAD and ETT maneuvers to increase successful intubation chances.

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