Airway management of a child after tracheal resection

Purpose: To report a strategy for minimizing airway risks and optimizing ai rway management in the post-reanastomosis phase of the anesthetic managemen t of a patient undergoing tracheal reconstruction. Clinical features: A 14-yr-old boy with squamous cell carcinoma of his trac hea underwent a tracheal resection and end-to-end reanastomosis for removal of tumour. This procedure was accomplished through a right thoracotomy. A thoracic epidural had been placed before induction of anesthesia through wh ich 3 mg morphine and 10 mi bupivacaine 0.25% with epinephrine were adminis tered during surgery, After chest wall closure the patient was allowed to r ecover spontaneous respiration and the trachea was extubated during deep an esthesia to eliminate airway response with coughing which might have stress ed the anastomosis, An infusion of bupivacaine 0.0625% and morphine (100 mu g.ml(-1)) was maintained until the third postoperative day, The patient ha d an unremarkable postoperative course and was discharged on the eighth pos toperative day. Conclusion: In this case thoracic epidural analgesia and tracheal extubatio n during deep anesthesia was a safe and effective strategy for minimizing a irway risks and optimizing airway management in after the reanastomosis pha se of tracheal resection.