Gao Hui, Yi Jie, Huang Yu-guang
Department of Anesthesiology, PUMC Hospital,CAMS and PUMC, Beijing,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2013 Jun;35(3):322-6. doi: 10.3881/j.issn.1000-503X.2013.03.000.
To summarize our experiences in anesthetic management for the resection of tracheal masses.
The clinical data of 15 patients with tracheal masses in Peking Union Medical College Hospital from 2002 to 2012 were analyzed retrospectively. Remarkable dyspnea and tracheal stenosis were observed in 12 patients. Standard orotracheal intubation was carried out in patients with less than 50% of tracheal lumen obstructed. The location of masses was critical for those with severe tracheal stenosis. Local anesthetics were applied and tracheostomy were performed in patients with masses located at the upper part of the trachea. Intubation above the masses was established in patients with masses located at the lower part of the trachea. Percutaneous cardiopulmonary support was introduced before anesthetic induction in a patient with severe respiratory distress and hypercapnea,then an endotracheal tube successfully passed the stenosis guided by a fiberoptic bronchoscope. General anesthesia was induced intravenously and muscle relaxants were applied in all patients. Succinylcholine was administrated in 5 of 6 difficult patients.
Airway management and anesthesia were performed successfully in all the 15 patients. After the operations,patients were extubated and discharged from the hospital without difficulty in respiration.
The successful airway management of tracheal masses depends on the degree and location of stenosis and the severity of dyspnea. Extracorporeal circulation is an optimal choice for those with critical airway occlusion and adequate oxygenation can not be accomplished with conventional anesthesia.
总结气管肿物切除术麻醉管理的经验。
回顾性分析2002年至2012年北京协和医院15例气管肿物患者的临床资料。12例患者有明显呼吸困难及气管狭窄。气管腔阻塞小于50%的患者行标准经口气管插管。对于气管严重狭窄的患者，肿物位置至关重要。肿物位于气管上段的患者采用局部麻醉并施行气管切开术。肿物位于气管下段的患者在肿物上方插管。1例严重呼吸窘迫和高碳酸血症患者在麻醉诱导前采用经皮心肺支持，然后在纤维支气管镜引导下气管导管成功通过狭窄部位。所有患者均采用静脉诱导全身麻醉并应用肌肉松弛剂。6例困难患者中有5例使用了琥珀胆碱。
15例患者气道管理和麻醉均成功。术后患者顺利拔管，呼吸无困难出院。
气管肿物气道管理的成功取决于狭窄程度和部位以及呼吸困难的严重程度。对于气道严重阻塞且常规麻醉无法实现充分氧合的患者，体外循环是最佳选择。
