Tracheal resection and reconstruction

Purpose: To review the literature on tracheal and carinal resection and rec onstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The ai rway management is extensively reviewed. Source: Articles obtained from a Medline search (1960 to October 1997; keyw ords: tracheal surgery, carinal surgery, airway management). Textbook liter ature including the bibliographies were also consulted. Principal Findings: Benign or malignant tracheal and carinal pathology caus ing obstruction can be managed in several ways but resection and reconstruc tion are the treatment of choice for most patients with tracheal stenosis o r tumour. Surgery of the trachea is a special endeavour where the airway is shared by the surgeon and the anesthesiologist. The principal anesthetic c onsideration is ventilation and oxygenation in the face of an open airway. Ventilation can be managed in different ways, including manual oxygen jet v entilation, high frequency jet ventilation, distal tracheal intubation, spo ntaneous ventilation, and cardiopulmonary bypass. Conclusion: The management of anesthesia for tracheal surgery presents many challenges to the anesthesiologist. Knowledge of the various techniques fo r airway management is crucial. Meticulous planning and communication betwe en the anesthesia and surgical teams are mandatory for the safe and success ful outcome of surgery for patients undergoing this procedure.