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. 2022 May;11(5):880-889.
doi: 10.21037/tlcr-22-302.

The strategy of non-intubated spontaneous ventilation anesthesia for upper tracheal surgery: a retrospective case series study

Yanran Zhou #  1 , Hengrui Liang #  2 , Ke Xu #  2 , Chao Yang  2 , Lixia Liang  1 , Qinglong Dong  1 , Hanyu Yang  1 , Hui Liu  1 , Yinfen Li  1 , Setu Patolia  3 , Jinwook Hwang  4 , Patrick Zardo  5 , Shuben Li  2 , Jianxing He  2 , Jun Liu  2
Affiliations

The strategy of non-intubated spontaneous ventilation anesthesia for upper tracheal surgery: a retrospective case series study

Yanran Zhou et al. Transl Lung Cancer Res. 2022 May.

Abstract

Background: Upper tracheal surgery is used to treat patients who with tracheal tumors or tracheal stenosis. The non-intubated spontaneous ventilation anesthesia (NSVA) may have advantages over endotracheal intubation and surgical cross-field intubation in upper tracheal surgery. This study aimed to illustrate and assess the feasibility of NSVA strategy for upper tracheal surgery.

Methods: This is a retrospective case series study in which 51 patients (from May 2015 to August 2020) who met the criteria in NSVA strategy were analyzed. Anesthesia was performed using total intravenous anesthesia (TIVA) combined with bilateral superficial cervical plexus block (CPB) or thoracic epidural anesthesia (TEA). Patients received spontaneous ventilation through laryngeal mask airway (LMA) during the surgery. Anesthesia conversion technique was applied to patients who met the anesthesia conversion criteria.

Results: In total, 51 patients met the NSVA criteria and were included in this study. Forty-six out of 51 patients (90%) had TIVA + bilateral superficial CPB and five patients (10%) had TIVA + TEA + CPB. During the airway-opened period, 46 patients had stable spontaneous ventilation. Five patients need anesthesia conversion, two patients had high-frequency ventilation (HFV), and three patients required cross-field intubation. Postoperative complications occurred in seven (14%) patients, no reintubation was needed after surgery. The median postoperative hospital stay was 6.31±4.30 days.

Conclusions: This NSVA strategy includes criteria for patient selection, preoperative assessment, surgical technique, airway management, criteria and technique for anesthesia conversion. The NSVA strategy is a feasible procedure in upper tracheal surgery.

Keywords: Spontaneous ventilation; anesthesia; resection and reconstruction; trachea.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-22-302/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Equipment used in NSVA upper tracheal surgery. 15-F sterile extra-long hollow tube. NSVA, non-intubated spontaneous ventilation anesthesia.
Figure 2
Figure 2
Two surgical approaches for upper tracheal surgery. (A) Cervical incision; (B) partial cervico-sternotomy.
Figure 3
Figure 3
Key techniques in upper tracheal surgery. (A) Reconfirmed margins of the lesion under the bronchoscopic view; (B) a sterile hollow tube was placed in the distal trachea to insufflate oxygen.
Figure 4
Figure 4
Flow chart. BMI, body mass index; HFV, high-frequency ventilation; SVA, spontaneous ventilation anesthesia; ICU, intensive care unit.
See this image and copyright information in PMC

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