Perioperative Anesthetic Considerations for Surgical and Non Surgical Management of Tracheal Stenosis
Wessam El-Said Mohamed Metwally;
Abstract
The trachea or windpipe is a cartilaginous and membranous tube, extending from the lower part of the larynx, on a level with the sixth cervical vertebra, to the upper border of the fifth thoracic vertebra, where it divides into the two bronchi, one for each lung.
The most common cause of Tracheal stenosis is trauma, which can be internal (eg. resulting from prolonged endotracheal intubation, tracheotomy, surgery, irradiation and endotracheal burns) or external (eg. blunt or penetrating neck trauma). Of these causes, it has been reported that prolonged endotracheal intubation is the leading cause of tracheal stenosis.
Tracheal stenosis is diagnosed by a thorough history and physical examination, radiologic and endoscopic evaluation. Rigid bronchoscopy is considered the gold standard for evaluating tracheal stenosis. Other investigations such as pulmonary function tests may also be helpful.
The goals of treatment are either cure or palliation. Recent studies showed that interventional bronchoscopy should be considered the first treatment of choice for the management of all types of simple stenosis. On the other hand complex stenosis need a multidisciplinary approach and often require surgery.
Despite the different approaches developed in recent years to manage tracheal stenosis, tracheal resection and reconstruction achieves excellent results and remains the gold standard treatment suitable for 99% of patients.
The anesthetic management during rigid bronchoscopy and tracheal resection and reconstruction are one of the most challenging situations for anesthesiologists. It requires the anesthesiologist and the surgeon to share the airway. The airway itself is abnormal and often tenuous, and the anesthesiologist must be able to rapidly employ a variety of techniques to secure and maintain the airway throughout the procedures.
Tracheal surgery is a demanding task for patient, anesthesiologist and surgeon. It is not without complications. Historically, the operative mortality rate of a tracheal resection and reconstruction operation ranged from 7% to 11%. Currently, experienced centers can perform this operation with a mortality as low as 3%.
The most common cause of Tracheal stenosis is trauma, which can be internal (eg. resulting from prolonged endotracheal intubation, tracheotomy, surgery, irradiation and endotracheal burns) or external (eg. blunt or penetrating neck trauma). Of these causes, it has been reported that prolonged endotracheal intubation is the leading cause of tracheal stenosis.
Tracheal stenosis is diagnosed by a thorough history and physical examination, radiologic and endoscopic evaluation. Rigid bronchoscopy is considered the gold standard for evaluating tracheal stenosis. Other investigations such as pulmonary function tests may also be helpful.
The goals of treatment are either cure or palliation. Recent studies showed that interventional bronchoscopy should be considered the first treatment of choice for the management of all types of simple stenosis. On the other hand complex stenosis need a multidisciplinary approach and often require surgery.
Despite the different approaches developed in recent years to manage tracheal stenosis, tracheal resection and reconstruction achieves excellent results and remains the gold standard treatment suitable for 99% of patients.
The anesthetic management during rigid bronchoscopy and tracheal resection and reconstruction are one of the most challenging situations for anesthesiologists. It requires the anesthesiologist and the surgeon to share the airway. The airway itself is abnormal and often tenuous, and the anesthesiologist must be able to rapidly employ a variety of techniques to secure and maintain the airway throughout the procedures.
Tracheal surgery is a demanding task for patient, anesthesiologist and surgeon. It is not without complications. Historically, the operative mortality rate of a tracheal resection and reconstruction operation ranged from 7% to 11%. Currently, experienced centers can perform this operation with a mortality as low as 3%.
Other data
| Title | Perioperative Anesthetic Considerations for Surgical and Non Surgical Management of Tracheal Stenosis | Other Titles | الأعتبارات التخديرية المحيطة بالتعامل الجراحي و الغير جراحي لحالات ضيق القصبة الهوائية | Authors | Wessam El-Said Mohamed Metwally | Issue Date | 2015 |
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