Ahuja Sanchit, Cohen Barak, Hinkelbein Jochen, Diemunsch Pierre, Ruetzler Kurt
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.
J Thorac Dis. 2016 Nov;8(11):3431-3441. doi: 10.21037/jtd.2016.11.57.
Tracheobronchial surgeries require close cooperation and extensive communication between the anesthesia providers and the surgeons. Anesthetic management of tracheal and bronchial pathologies differ basically from regular upper airways management, due access to the patients airway is limited, mostly even practically impossible for the anesthesia providers. As a consequence, the surgeon overtakes responsibility for the airway access from the anesthesia provider in the variety of the cases. Preoperative recognition of a difficult airway, detailed planning and being aware of plan B and plan C are the elementary keys to success. Providers have to be aware, that preoperative airway assessment does not always correlate with the ease of oxygenation and ventilation. Therefore, various methods have been described in the literature and several authors have adopted unique ways to manage the airways in a successful manner. With the advancement of surgical techniques over the years, anesthetic management has also evolved tremendously to match the needs. The commonly encountered conditions requiring surgical interventions include post-intubation stenosis and foreign body aspiration. In this review we will discuss the most common pathologies of tracheobronchial lesions and specific anesthetic management considerations related to them.
气管支气管手术需要麻醉医生和外科医生密切合作与广泛沟通。气管和支气管病变的麻醉管理与常规上呼吸道管理基本不同，因为麻醉医生接近患者气道的途径有限，在大多数情况下甚至几乎不可能。因此，在各种情况下，外科医生会从麻醉医生手中接过气道管理的责任。术前识别困难气道、进行详细规划并知晓备用方案和第三套方案是成功的基本关键。麻醉医生必须意识到，术前气道评估并不总是与氧合和通气的难易程度相关。因此，文献中描述了各种方法，几位作者也采用了独特的方式成功管理气道。多年来，随着手术技术的进步，麻醉管理也有了巨大发展以满足需求。需要手术干预的常见情况包括插管后狭窄和异物吸入。在本综述中，我们将讨论气管支气管病变最常见的病理情况以及与之相关的具体麻醉管理注意事项。
