Cervical tracheal resection without intubation

Abstract

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, 27±3 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 109±9 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, 12±2 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.

Keywords

benign tracheal stenosis / tracheal resection / non-intubated / supraglottic airway device / stenting / dexmedetomidine

References

[1] Parshin V.D., Vyzhigina M.A., Rusakov M.A., Parshin V.V., Titov V.A., Starostin A.V. Postresuscitation cicatricial tracheal stenosis. Current state of the problem — the successes, the hopes and disappointments. Anesteziologiya i reanimatologiya. 2016; 61 (5): 360–366. (In Russ.) DOI: 10.18821/0201-7563-2016-61-5-360-366.

[2] Паршин В.Д., Выжигина М.А., Русаков М.А., Паршин В.В., Титов В.А., Старостин А.В. Постинтубационный постреанимационный рубцовый стеноз трахеи. Современное состояние проблемы — успехи, надежды и разочарования. Анестезиол. и реаниматол. 2016; 61 (5): 360–366. DOI: 10.18821/0201-7563-2016-61-5-360-366.

[3] Grillo H.C. Development of tracheal surgery: a historical review. Part 1: techniques of tracheal surgery. Ann. Thorac. Surg. 2003; 75: 610–619. DOI: 10.1016/s0003-4975(02)04108-5.

[4] Vyzhigina M.A. Anesteziya i podderzhanie gazoobmena pri operatsiyakh na trakhee i glavnykh bronkhakh. Khirurgiya trakhei s atlasom opera­tivnoy khi­rurgii. (Anesthesia and maintenance of gas exchange during operations on the trachea and main bronchi. Surgery of the trachea with an atlas of operative surgery.) Ed. by V.D. Parshin, V.A. Porkhanov. M.: Al'di-Print. 2010; 22–75. (In Russ.)

[5] Выжигина М.А. Анестезия и поддержание газообмена при операциях на трахее и главных бронхах. Хирургия трахеи с атласом оперативной хирургии. Под ред. В.Д. Паршина, В.А. Порханова. М.: Альди-Принт. 2010; 22–75.

[6] Lingard L., Garwood S., Poenaru D. Tensions influencing operating room team function: does institutional context make a difference. Med. Educ. 2004; 38: 691–699. DOI: 10.1111/j.1365-2929.2004.01844.x.

[7] Chitilian H.V., Bao X., Mathisen D.J., Alfille P.H. Anesthesia for airway surgery. Thorac. Surg. Clin. 2018; 28: 249–255. DOI: 10.1016/j.thorsurg.2018.04.001.

[8] Hobai I.A., Chhangani S.V., Alfille P.H. Anesthesia for tracheal resection and reconstruction. Anesthesiol. Clin. 2012; 30 (4): 709–730. DOI: 10.1016/j.anclin.2012.08.012.

[9] Alekseev A.V., Vyzhigina M.A., Bunyatyan A.A., Par­shin V.D., Titov V.A., Lavrinenko V.Yu. Application of apnoetic oxygenation in tracheal surgery. Anesteziolo­giya i reanimatologiya. 2017; 62 (1): 35–38. (In Russ.) DOI: 10.18821/0201-7563-2017-62-1-35-38.

[10] Алексеев А.В., Выжигина М.А., Бунятян А.А., Паршин В.Д., Титов В.А., Лавриненко В.Ю. Применение потоковой апноэтической оксигенации в хирургии трахеи. Анестезиол. и реаниматол. 2017; 62 (1): 35–38. DOI: 10.18821/0201-7563-2017-62-1-35-38.

[11] Sihag S., Wright C.D. Prevention and management of complications following tracheal resection. Thorac. Surg. Clin. 2015; 25 (4): 499–508. DOI: 10.1016/j.thorsurg.2015.07.011.

[12] Wiedemann K., Männle C. Anesthesia and gas exchange in tracheal surgery. Thorac. Surg. Clin. 2014; 24: 13–25. DOI: 10.1016/j.thorsurg.2013.10.001.

[13] Biro P., Hegi T.R., Weder W., Spahn D.R. Laryngeal mask airway and high-frequency jet ventilation for the resection of a high-grade upper tracheal stenosis. J. Clin. ­Anest. 2001; 13: 141–143. DOI: 10.1016/s0952-8180(01)00231-8.

[14] Hatipoglu Z., Turktan M., Avci A. The anesthesia of trachea and bronchus surgery. J. Thorac. Dis. 2016; 8 (11): 3442–3451. DOI: 10.21037/jtd.2016.11.35.

[15] Krecmerova M., Schutzner J., Schutzner J., Michael P., Johnson P., Vymazal T. Laryngeal mask for airway management in open tracheal surgery-a retrospective ana­lysis of 54 cases. J. Thorac. Dis. 2018; 10 (5): 2567–2572. DOI: 10.21037/jtd.2018.04.73.

[16] Zardo P., Kreft T., Hachenberg T. Airway management via laryngeal mask in laryngotracheal resection. Thorac. Cardiovasc. Surg. Rep. 2016; 5: 1–3. DOI: 10.1055/s-0035-1556061.

[17] Kovalev M.G., Akopov A.L., Polushin Yu.S., Geroeva A.N., Krivov V.O., Gerasin A.V., Ilyin A.A., Kazakov N.V. Anes­thesia for resection of the trachea without its intubation. Vestnik anesteziologii i reanimatologii. 2020; 17 (1): 37–45. (In Russ.) DOI: 10.21292/2078-5658-2020-16-1-37-45.

[18] Ковалёв М.Г., Акопов А.Л., Полушин Ю.С., Героева А.Н., Кривов В.О., Герасин А.В., Ильин А.А., Казаков Н.В. Анестезиологическое обеспечение циркулярной резекции трахеи без её интубации. Вестн. анестезиол. реаниматол. 2020; 17 (1): 37–45. DOI: 10.21292/2078-5658-2020-16-1-37-45.

[19] Ayub A., Al-Ayoubi A.M., Bhora F.Y. Stents for airway strictures: selection and results. J. Thorac. Dis. 2017; 9 (Suppl. 2): 116–121. DOI: 10.21037/jtd.2017.01.56.

[20] Kashii T., Nabatame M., Okura N., Fujinaga A., Namoto K., Mori M., Tsujimura S. Successful use of the i-gel and Dexmedetomidine for tracheal resection and construction surgery in a patient with severe tracheal stenosis. ­Masui. 2016; 65 (4): 366–369. PMID: 27188107.

[21] Mantz J., Josserand J., Hamada S. Dexmedetomidine: new insights. Eur. J. Anaesthesiol. 2011; 28 (1): 3–6. DOI: 10.1097/EJA.0b013e32833e266d.

[22] Kovalev M.G., Shlyk I.V., Polushin Yu.S., Akopov A.L., Smirnov A.A., Rusanov A.A. Experience of using dexmedetomidine for drug sedation in intraluminal endoscopic interventions. Vestnik anesteziologii i reanimatologii. 2016; 13 (6): 40–47. (In Russ.) DOI: 10.21292/2078-5658-2016-13-6-40-47.

[23] Ковалёв М.Г., Шлык И.В., Полушин Ю.С., Акопов А.Л., Смирнов А.А., Русанов А.А. Опыт использования дексмедетомидина для проведения медикаментозной седации при внутрипросветных эндоскопических вмешательствах. Вестн. анестезиол. ­реаниматол. 2016; 13 (6): 40–47. DOI: 10.21292/2078-5658-2016-13-6-40-47.

[24] Parshin V.D., Volkov A.A., Parshin V.V., Vishnevskaia G.A. Suture after circular tracheal resection. Khi­rurgiya. Zhurnal im. N.I. Pirogova. 2011; (12): 4–9. (In Russ.)

[25] Паршин В.Д., Волков А.А., Паршин В.В., Вишневская Г.А. Шов после циркулярной резекции трахеи. Хирургия. Журнал им. Н.И. Пирогова. 2011; (12): 4–9.

RIGHTS & PERMISSIONS

Akopov A.A., Kovalev M.G.