Caronia Francesco Paolo, Loizzi Domenico, Nicolosi Tommaso, Castorina Sergio, Fiorelli Alfonso
Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
Thoracic Surgery Unit, Università degli Studi di Foggia, Foggia, Italy.
Head Neck. 2017 Dec;39(12):E114-E117. doi: 10.1002/hed.24942. Epub 2017 Sep 27.
We reported a tubeless tracheal resection and reconstruction for the management of benign posttracheostomy tracheal stenosis.
A 34-year-old man with stridor, severe respiratory distress, and recurrent pneumonia was referred to our attention for treatment of benign posttracheostomy tracheal stenosis. As he refused general anesthesia, the procedure was performed while he was under local anesthesia and spontaneous ventilation.
Sedation was started with infusion of dexmedetomidine 0.7 mg/kg/min and of remifentanil 0.5 mg/kg/h; also, 40%-50% oxygen was delivered using a laryngeal mask at a rate of 3.5 mL/min. An additional dose of 2% lidocaine was injected into the surgical site during the operation to achieve an adequate level of anesthesia. A standard resection and reconstruction of trachea was carried out and no recurrence was found in the follow-up of 41 months.
Tubeless tracheal surgery seems to be a feasible and safe procedure. Larger prospective series should validate our results.
我们报道了一种无管气管切除重建术用于治疗良性气管切开术后气管狭窄。
一名34岁男性，有喘鸣、严重呼吸窘迫和反复肺炎，因良性气管切开术后气管狭窄前来接受治疗。由于他拒绝全身麻醉，手术在局部麻醉和自主通气下进行。
开始输注右美托咪定0.7毫克/千克/分钟和瑞芬太尼0.5毫克/千克/小时进行镇静；同时，使用喉罩以3.5毫升/分钟的速率输送40%-50%的氧气。术中在手术部位额外注射一剂2%利多卡因以达到足够的麻醉水平。进行了标准的气管切除重建术，在41个月的随访中未发现复发。
无管气管手术似乎是一种可行且安全的手术方法。更大规模的前瞻性系列研究应验证我们的结果。
