SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anest...SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anesthesiologist. Life-threa- tening airway obstruction can make the patient＇s gas ex- change extremely difficult. Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis.1 Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists.展开更多
BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of...BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.展开更多
To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the s...To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum was used to reconstruct the tracheal defect when the blood supply to the ipsilateral sternocleidomastoideus was destroyed because of lymphonode clearing or radiotherapy.The pedicle of the musculo-periosteum flap was dissected adequately and the blood supply was protected carefully.Results All flaps survived with epithelization and osteogenesis.The endotracheal tubes were pulled out safely without trachea stenosis in all the patients.Conclusion The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum could reconstruct the tracheal defect when the ipsilateral blood supply was damaged.This method extends the application of the musculo-periosteum flap.3 refs,4 figs.展开更多
Objective:The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies.Methods:The retrospective study was designed to analyze patients with diagnosed primary or...Objective:The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies.Methods:The retrospective study was designed to analyze patients with diagnosed primary or secondary tracheal tumors from 1991 to 2020.Surgical techniques,complications and prognosis were reviewed.Airway status and patient outcomes were the principal follow-up measures.Tracheal defects were classified into two plane sizes(vertical(V)and horizontal(H)planes).Vertical defects were further categorized into three groups based on their tracheal ring numbers(V 1,≤5 rings;V 2,6-10 rings;and V 3,>10 rings).Tracheal defects with horizontal plane size H 1 and H 2 represent defects less and more than one-half the circumference of trachea.Thus,suitable reconstruction strategies were planned primarily based on"V"and"H"classifications.The reconstruction strategies performed were sleeve resection followed by an end-to-end anastomosis,window resection with sternocleidomastoid myoperiosteal flap reconstruction,defects conversion with rotation anastomosis,and modified tracheostomy with secondary flap reconstruction.Results:A total of 106 patients diagnosed with tracheal defects were enrolled in the study,of whom 59 patients underwent sleeve resection followed by end-to-end anastomosis;40 patients received window resection alongside sternocleidomastoid(SCM)myoperiosteal flap reconstruction;five patients received converting defects with rotation anastomosis and two patients underwent modified tracheostomy with secondary stage flap reconstruction.Lumen stenosis occurred in three V 2H 1 defect cases and were treated by a second reconstruction surgery.Iatrogenic unilateral recurrent laryngeal nerve paralysis occurred in two patients with the V 3H 2 defect type,who were treated by temporary tracheotomy and partial vocal cord resection and extubated successfully during follow-up.All 106 patients achieved airway patency with adequate laryngeal function at the end of follow-up.No anastomotic dehiscence or bleeding occurred in any patient postoperatively.Conclusion:Though a significant number of multicenter studies concerning the reconstruction and classification of tracheal defects are needed,the study herein provides a novel classification of tracheal defects,which is primarily developed on the defect size.Therefore,the study might serve as a potential source for identifying suitable reconstruction strategies for practitioners.展开更多
文摘SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anesthesiologist. Life-threa- tening airway obstruction can make the patient＇s gas ex- change extremely difficult. Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis.1 Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists.
文摘BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.
文摘To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum was used to reconstruct the tracheal defect when the blood supply to the ipsilateral sternocleidomastoideus was destroyed because of lymphonode clearing or radiotherapy.The pedicle of the musculo-periosteum flap was dissected adequately and the blood supply was protected carefully.Results All flaps survived with epithelization and osteogenesis.The endotracheal tubes were pulled out safely without trachea stenosis in all the patients.Conclusion The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum could reconstruct the tracheal defect when the ipsilateral blood supply was damaged.This method extends the application of the musculo-periosteum flap.3 refs,4 figs.
文摘Objective:The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies.Methods:The retrospective study was designed to analyze patients with diagnosed primary or secondary tracheal tumors from 1991 to 2020.Surgical techniques,complications and prognosis were reviewed.Airway status and patient outcomes were the principal follow-up measures.Tracheal defects were classified into two plane sizes(vertical(V)and horizontal(H)planes).Vertical defects were further categorized into three groups based on their tracheal ring numbers(V 1,≤5 rings;V 2,6-10 rings;and V 3,>10 rings).Tracheal defects with horizontal plane size H 1 and H 2 represent defects less and more than one-half the circumference of trachea.Thus,suitable reconstruction strategies were planned primarily based on"V"and"H"classifications.The reconstruction strategies performed were sleeve resection followed by an end-to-end anastomosis,window resection with sternocleidomastoid myoperiosteal flap reconstruction,defects conversion with rotation anastomosis,and modified tracheostomy with secondary flap reconstruction.Results:A total of 106 patients diagnosed with tracheal defects were enrolled in the study,of whom 59 patients underwent sleeve resection followed by end-to-end anastomosis;40 patients received window resection alongside sternocleidomastoid(SCM)myoperiosteal flap reconstruction;five patients received converting defects with rotation anastomosis and two patients underwent modified tracheostomy with secondary stage flap reconstruction.Lumen stenosis occurred in three V 2H 1 defect cases and were treated by a second reconstruction surgery.Iatrogenic unilateral recurrent laryngeal nerve paralysis occurred in two patients with the V 3H 2 defect type,who were treated by temporary tracheotomy and partial vocal cord resection and extubated successfully during follow-up.All 106 patients achieved airway patency with adequate laryngeal function at the end of follow-up.No anastomotic dehiscence or bleeding occurred in any patient postoperatively.Conclusion:Though a significant number of multicenter studies concerning the reconstruction and classification of tracheal defects are needed,the study herein provides a novel classification of tracheal defects,which is primarily developed on the defect size.Therefore,the study might serve as a potential source for identifying suitable reconstruction strategies for practitioners.
