[Airway management and use of miniature extracorporeal circulation in tracheal surgery: a single center experience].

ABSTRACT

OBJECTIVE: To review the methods involved in airway management of tracheal surgery and to consider the role of extracorporeal circulation. METHODS: A total of 91 tracheal surgeries were performed from January 2008 to February 2012, including 60 cases of tumor, 8 cases of post-traumatic stenosis and 23 cases of post-tracheostomy stenosis. There were 76 male and 15 female patients, aged from 4 to 77 years. Anesthetic plans were made according to the severity and position of stenosis. Rapid sequent induction intubations were conducted on 56 patients, tracheostomy intubations on 25 patients, awake intubations on 3 patients, extracorporeal circulation on 6 patients and emergent sternotmy and tracheostomy on 1 patient. Miniature extracorporeal circulation systems were used in all extracorporeal circulation case. RESULTS: All patients discharged without major complications. There were 2 cases of massive bleeding during operations, 1 case of post-operative tracheal fistula and 1 case of post-operative incision infection. All these 4 cases were treated properly and got cured. One patient on whom extracorporeal circulation was unable to set up underwent 6 minutes of hypoxia before sterotomy and tracheostomy. All the extracorporeal circulation cases were hemodynamically stable during bypass and none of them need massive transfusion. The miniature extracorporeal circulation system was convenient to use and especially suitable for tracheal surgery. CONCLUSIONS: Various advanced anesthesia techniques can ensure a safe airway for most tracheal surgeries. However, extracorporeal circulation plays a major role in high risk cases. It is important to set up a miniature extracorporeal circulation circuit that is especially suitable for tracheal surgery.