University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany.
Curr Opin Anaesthesiol. 2022 Feb 1;35(1):75-81. doi: 10.1097/ACO.0000000000001082.
The aim of this review is to provide an overview of current anesthetic management of tracheal and carinal resection and reconstruction.
In addition to the traditional anesthetic approach using conventional tracheal intubation after induction of general anesthesia and cross-field intubation or jet-ventilation once the airway has been surgically opened, there is a trend toward less invasive anesthetic procedures. Regional anesthetic techniques and approaches focusing on the maintenance of spontaneous respiration have emerged. Especially for cervical tracheal stenosis, laryngeal mask airways appear to be an advantageous alternative to tracheal intubation.Extracorporeal support can ensure adequate gas exchange and/or perfusion during complex resections and reconstructions without interference of airway devices with the operative field. It also serves as an effective rescue technique in case other approaches fail.
The spectrum of available anesthetic techniques for major airway surgery is immense. To find the safest approach for the individual patient, comprehensive interdisciplinary planning is essential. The location and anatomic consistency of the stenosis, comorbidities, the functional status of respiratory system, as well as the planned reconstructive technique need to be considered. Until more data is available, however, a reliable evidence-based comparison of different approaches is not possible.
本文旨在概述当前气管和隆嵴切除术及重建术的麻醉管理。
除了传统的麻醉方法，即在全身麻醉诱导后进行常规气管插管，并在气道切开后进行交叉场插管或射流通气外，还出现了一种倾向于采用微创麻醉程序的趋势。重点在于维持自主呼吸的区域麻醉技术和方法已经出现。特别是对于颈段气管狭窄，喉罩气道似乎是气管插管的有利替代方法。体外支持可以确保在复杂切除和重建过程中进行充分的气体交换和/或灌注，而不会干扰气道装置与手术区域。如果其他方法失败，它也可以作为一种有效的抢救技术。
用于主要气道手术的麻醉技术范围非常广泛。为了为每个患者找到最安全的方法，需要进行全面的跨学科规划。需要考虑狭窄的位置和解剖一致性、合并症、呼吸系统的功能状态以及计划的重建技术。然而，在获得更多数据之前，不可能对不同方法进行可靠的基于证据的比较。
