A New Approach in Airway Management for Tracheal Resection and Anastomosis: A Single-Center Prospective Study

Abstract

Objectives: The evaluation of the use of laryngeal mask airways (LMA) as an alternative form of airway management for surgical tracheal reconstruction.

Design: A prospective case series.

Setting: At a single German university hospital.

Participants: Ten patients.

Interventions: The use of LMA for airway management in surgical reconstruction of the trachea.

Measurements and main results: Ten patients with tracheal stenosis of 50% to 90% were enrolled prospectively during the study period. The airway management consisted of the insertion of an LMA. During resection and reconstruction, high-frequency jet ventilation was used. Several arterial blood gas analyses (ABG) were performed before, during, and after the tracheal resection and reconstruction. All values were presented as median and interquartile ranges or as absolute and relative values, and no emergency change to cross-field intubation was necessary. The lowest PaO₂ was 93 mmHg in 1 patient after 20 minutes of jet ventilation, whereas PaO₂ increased after the induction phase and remained stable in 9 patients. There were no intraoperative complications related to anesthetic management apart from transient hypercarbia during and after jet ventilation. Preoperative and postoperative ABG were comparable. One patient required immediate postoperative ventilatory support. Two patients developed postoperative pneumonia, leading to their admission to the intensive care unit. One patient was operated with a palliative approach due to massive dyspnea and died in the next postoperative course.

Conclusions: The use of LMA is an alternative option in airway management for tracheal reconstruction, even in patients with significant tracheal stenosis. Potential advantages compared to tracheal intubation are unimpaired access to the operative field and the lack of stress on the fresh anastomosis.

Keywords: airway management; high-frequency jet ventilation; laryngeal mask airways; nonintubated anesthesia; tracheal resection.