| Anesthetic Management for Reconstruetive Surgery of Tracheal Stenosis using Cardiopulmonary Bypaas . |
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Won Chul Chung, So Young Yoon, Young Joo Kim, Sang Ki Paik, Kwang Won Park |
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Department of Anesthesiology, Yonsei University School of Medicine, Seoul, Korea. |
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| Abstract |
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Tracheal stenosis is now a well-recognized, and very serious complication following increased use endotracheal tubes of tracheostomies with air inflated cuffed tubes and assisted ventilation. Up to 10% of patients surviving treatment have been reported to develop stenosis following closure of tracheostomy and some prospective studies predict a 16~20% incidence of stricture following prolonged cuffed tube ventilation. The most important principle is prevention.
Once stenosis is established, the logical approach is resection of the stenotic segment and reestablishment of an adequate airway by primary anastomosis or the insertion of a tracheal substitute. In this regard, Pearsor, Grillo, Naef and Binet have made major contributions to the technique of reconstruction of the tracheo-bornchial tree after extensive resection. Strictures are described both in the region of the stoma and at the level of the inflatable cuff.
Anesthetic management of these patients should focus on maintenance of the airway and adequate ventilation. If not, hypoxia or cardiac arrest can occur during a prolonged operation due to alvsolar hypoventilation. Extracorporeal circulation for tracheal stenosis reconstruction was first used by Woods for prevention of hypercarbia and hypoxia. The Department of Anesthesiology of Yonsei University has had experience in the anesthetic management of two cases of tracheal stenosis reconstruction using extracorporeal circulation during surgery, these cases are reported along hear with references from the literature. |
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