Gao Hui, Zhu Bin, Yi Jie, Ye Tie-hu, Huang Yu-guang
Department of Anesthesiology, Chinese Academy of Medical Sciences, Beijing, China.
Chin Med Sci J. 2013 Mar;28(1):55-7. doi: 10.1016/s1001-9294(13)60020-6.
Severe tracheal stenosis can not only cause critical medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on the physicians, particularly the anesthesiologist. Life-threatening airway obstruction can make the patient's gas exchange extremely difficult.Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis. Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists. In these cases, airway management is the top issue for the anesthesiologist, and the level of difficulty varies with stenosis location, severity of stenosis, and surgical technique. Extracorporeal membrane oxygenation (ECMO), or cardiopulmonary bypass (CPB), is rarely utilized for the surgery, but for those impossible airways due to nearly complete tracheal obstruction, ECMO or CPB could be the final choice for anesthesiologists. Here we report a case of successful urgent airway management for tracheal resection and reconstruction assisted by temporary CPB.
严重气管狭窄不仅会引发严重的医疗问题，如严重呼吸急促、缺氧甚至端坐呼吸，还会给医生，尤其是麻醉医生带来巨大挑战。危及生命的气道梗阻会使患者的气体交换极其困难。尽管对于气管狭窄的治疗有多种选择，但通常情况下，气管切除及后续重建是严重气道狭窄的首选治疗方法。手术成功依赖于外科医生和麻醉医生之间的密切沟通与合作。在这些病例中，气道管理是麻醉医生面临的首要问题，其难度水平因狭窄部位、狭窄严重程度和手术技术而异。体外膜肺氧合（ECMO）或体外循环（CPB）在该手术中很少使用，但对于那些因几乎完全气管梗阻而无法建立气道的情况，ECMO或CPB可能是麻醉医生的最终选择。在此，我们报告一例在临时CPB辅助下成功进行气管切除及重建的紧急气道管理病例。
