Schieren Mark, Böhmer Andreas, Dusse Fabian, Koryllos Aris, Wappler Frank, Defosse Jerome
Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany.
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1351-1358. doi: 10.1053/j.jvca.2017.03.020. Epub 2017 Mar 24.
Although endotracheal intubation, surgical crossfield intubation, and jet ventilation are standard techniques for airway management in tracheal resections, there are also reports of new approaches, ranging from regional anesthesia to extracorporeal support. The objective was to outline the entire spectrum of new airway techniques.
The literature databases PubMed/Medline and the Cochrane Library were searched systematically for prospective and retrospective trials as well as case reports on tracheal resections.
No restrictions applied to hospital types or settings.
Adult patients undergoing surgical resections of noncongenital tracheal stenoses with end-to-end anastomoses.
Airway management techniques were divided into conventional and new approaches and analyzed regarding their potential risks and benefits.
A total of 59 publications (n = 797 patients) were included. The majority of publications (71.2%) describe conventional airway techniques. Endotracheal tube placement after induction of general anesthesia and surgical crossfield intubation after incision of the trachea were used most frequently without major complications. A total of 7 new approaches were identified, including 4 different regional anesthetic techniques (25 cases), supraglottic airways (4 cases), and new forms of extracorporeal support (25 cases). Overall failure rates of new techniques were low (1.8%). Details on patient selection and procedural specifics are provided.
New approaches have several theoretical benefits, yet further research is required to establish criteria for patient selection and evaluate procedural safety. Given the low level of evidence, it currently is impossible to compare methods of airway management regarding outcome-related risks and benefits.
尽管气管插管、手术跨野插管和喷射通气是气管切除术中气道管理的标准技术，但也有关于新方法的报道，从区域麻醉到体外支持不等。目的是概述新气道技术的全貌。
系统检索文献数据库PubMed/Medline和Cochrane图书馆，查找关于气管切除的前瞻性和回顾性试验以及病例报告。
对医院类型或环境不设限制。
接受非先天性气管狭窄端端吻合手术切除的成年患者。
气道管理技术分为传统方法和新方法，并分析其潜在风险和益处。
共纳入59篇出版物（n = 797例患者）。大多数出版物（71.2%）描述了传统气道技术。全身麻醉诱导后气管插管和气管切开后手术跨野插管使用最为频繁，且无重大并发症。共确定了7种新方法，包括4种不同的区域麻醉技术（25例）、声门上气道（4例）和新型体外支持（25例）。新技术的总体失败率较低（1.8%）。提供了患者选择和手术细节的详细信息。
新方法有若干理论上的益处，但需要进一步研究以确定患者选择标准并评估手术安全性。鉴于证据水平较低，目前无法比较气道管理方法在与结果相关的风险和益处方面的差异。
