Difference between revisions of "Tracheal resection"
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{{Infobox surgical procedure | |||
| anesthesia_type = General | |||
| airway = Invasive Airway(ETT, Tracheostomy) | |||
| lines_access = Large bore, PIV, Arterial line, CVC dependent on comorbidities | |||
| monitors = Standard ASA monitors, Arterial line, +/- CVP, +/- TEE, foley | |||
| considerations_preoperative = Location and extent of airway stenosis, Presence of tracheostomy and of what lifespam | |||
| considerations_intraoperative = Minimize FiO2 as airway is in surgical field, +/- neuromonitoring | |||
| considerations_postoperative = PONV | |||
}} | |||
Provide a brief summary here. | |||
== Overview == | |||
Tracheal resection is a surgical procedure performed to remove diseased or obstructive segments of the trachea, often to treat benign or malignant tumors, traumatic stenosis, or congenital anomalies. The affected segment is excised, and the healthy ends are anastomosed to restore airway continuity. This procedure can significantly improve airway patency and patient quality of life. | |||
=== Indications<!-- List and/or describe the indications for this surgical procedure. --> === | |||
* Most commonly due to "acquired stenosis" typically caused by prolonged intubation or tracheostomy. | |||
** Typically this stenosis is so severe and has failed attempts at ballon dilation or stenting. | |||
* Malignant tumors of the trachea(<0.01% of all tumors, and 0.2% of respiratory tract tumors) | |||
* Benign tumors causing airway obstruction | |||
* Tracheal stenosis due to trauma, post-intubation injury, or radiation | |||
* Congenital anomalies such as tracheal stenosis or malformation | |||
* Tracheal trauma or injury repair | |||
=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> === | |||
* Patients with airway stenosis often have prexiitng tracheosotmy, which can be intubated directly with ETT. In other cases, the procedure can be done with rigid bronchoscopy or via anterior cervical approach. | |||
* Three distances must be measured when planning the resection portion of the procedure: vocal cords to the carina, distal tip of the lesion to the carina, and proximal tip of the lesion to vocal cords. | |||
* The diseased segment is resected with clear margins. | |||
* Resection for patients with severe subglottic stenosis high in the cervical trachea may require partial excision of the cricoid cartilage. | |||
* End-to-end anastomosis is performed with absorbable sutures, ensuring tension-free closure. | |||
* Consider releasing maneuvers (e.g., suprahyoid release) if tension is high. | |||
* Use of intraoperative bronchoscopy | |||
== Preoperative management == | |||
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | |||
{| class="wikitable" | |||
|+ | |||
!System | |||
!Considerations | |||
|- | |||
|Airway | |||
| | |||
* The anatomic location and percentage of obstruction were assessed endoscopically and graded I to IV. (Cotten Classification | |||
* Ascertain location and extent of stenosis | |||
* Stenosis can be classified as ''structural'' or ''fixed''(intraluminal or extraluminal) | |||
* Stenosis can be classified by ''dynamic'' vs. ''functional'' | |||
* Rigid bronchoscopy may be used intraoperatively for airway access. | |||
** Maintain spontaneous ventilation during critical phases if possible. | |||
*** Be prepared for elective or emergent conversion to alternative airway management (e.g., cross-field ventilation). | |||
|- | |||
|Neurologic | |||
| | |||
|- | |||
|Cardiovascular | |||
| | |||
*Invasive arterial line for continuous blood pressure monitoring. | |||
*Preparedness for cardiopulmonary bypass (CPB) or ECMO if needed. | |||
|- | |||
|Pulmonary | |||
| | |||
* Oxygen requirement at baseline | |||
* Ability or inability to lie supine | |||
* Presence of comorbid condition that will increase likelihood of requiring positive pressure ventilation post operatively, as this may be a contraindication for procedure(increases tension on anastomosis) | |||
|- | |||
|Gastrointestinal | |||
| | |||
|- | |||
|Hematologic | |||
| | |||
|- | |||
|Renal | |||
|Foley, monitor urine output | |||
|- | |||
|Endocrine | |||
| | |||
|- | |||
|Other | |||
| | |||
|} | |||
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | |||
== Intraoperative management == | |||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | |||
Standard ASA monitors: ECG, pulse oximetry, non-invasive blood pressure, capnography. | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | |||
Preoxygenation, followed by intubation | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | |||
Supine, often with shoulder roll(especially if done under rigid bronchoscopy) | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | |||
== Postoperative management == | |||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | |||
* Transfer to ICU for close observation. | |||
* Patients often extubated on post-op day 5-7 | |||
* Continuous respiratory and hemodynamic monitoring. | |||
* Assess for airway patency and adequacy of ventilation, often requiring multiple bronchoscopies for monitoring and visualization of anastomotic integrity | |||
=== Pain management === | |||
* Adequate analgesia using minimal opioids, NSAIDs, and local anesthetic techniques. | |||
* Avoid excessive coughing or strain to protect the anastomosis. | |||
* Non-narcotic pain management are encouraged to prevent postoperative nausea, leading to vomiting, neck hyperextension, and potential aspiration. | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | |||
* Anastomotic dehiscence or restenosis | |||
** Most commonly cacused by tension on the anastamotic line. | |||
* Airway obstruction | |||
** Laryngeal edema. | |||
* Hemorrhage, can be lifethreatening via tracheoinnominate fistula when anterior anastomosis has become dehiscent | |||
* Infection | |||
* Recurrent laryngeal nerve injury causing hoarseness or airway compromise | |||
* Tracheoesophageal fistula (rare) | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | |||
{| class="wikitable wikitable-horizontal-scroll" | |||
|+ | |||
! | |||
!Variant 1 | |||
!Variant 2 | |||
|- | |||
|Unique considerations | |||
| | |||
| | |||
|- | |||
|Indications | |||
| | |||
| | |||
|- | |||
|Position | |||
| | |||
| | |||
|- | |||
|Surgical time | |||
| | |||
| | |||
|- | |||
|EBL | |||
| | |||
| | |||
|- | |||
|Postoperative disposition | |||
| | |||
| | |||
|- | |||
|Pain management | |||
| | |||
| | |||
|- | |||
|Potential complications | |||
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|} | |||
== References == | |||
[[Category:Surgical procedures]] |
Latest revision as of 08:44, 24 June 2025
Anesthesia type |
General |
---|---|
Airway |
Invasive Airway(ETT, Tracheostomy) |
Lines and access |
Large bore, PIV, Arterial line, CVC dependent on comorbidities |
Monitors |
Standard ASA monitors, Arterial line, +/- CVP, +/- TEE, foley |
Primary anesthetic considerations | |
Preoperative |
Location and extent of airway stenosis, Presence of tracheostomy and of what lifespam |
Intraoperative |
Minimize FiO2 as airway is in surgical field, +/- neuromonitoring |
Postoperative |
PONV |
Article quality | |
Editor rating | |
User likes | 0 |
Provide a brief summary here.
Overview
Tracheal resection is a surgical procedure performed to remove diseased or obstructive segments of the trachea, often to treat benign or malignant tumors, traumatic stenosis, or congenital anomalies. The affected segment is excised, and the healthy ends are anastomosed to restore airway continuity. This procedure can significantly improve airway patency and patient quality of life.
Indications
- Most commonly due to "acquired stenosis" typically caused by prolonged intubation or tracheostomy.
- Typically this stenosis is so severe and has failed attempts at ballon dilation or stenting.
- Malignant tumors of the trachea(<0.01% of all tumors, and 0.2% of respiratory tract tumors)
- Benign tumors causing airway obstruction
- Tracheal stenosis due to trauma, post-intubation injury, or radiation
- Congenital anomalies such as tracheal stenosis or malformation
- Tracheal trauma or injury repair
Surgical procedure
- Patients with airway stenosis often have prexiitng tracheosotmy, which can be intubated directly with ETT. In other cases, the procedure can be done with rigid bronchoscopy or via anterior cervical approach.
- Three distances must be measured when planning the resection portion of the procedure: vocal cords to the carina, distal tip of the lesion to the carina, and proximal tip of the lesion to vocal cords.
- The diseased segment is resected with clear margins.
- Resection for patients with severe subglottic stenosis high in the cervical trachea may require partial excision of the cricoid cartilage.
- End-to-end anastomosis is performed with absorbable sutures, ensuring tension-free closure.
- Consider releasing maneuvers (e.g., suprahyoid release) if tension is high.
- Use of intraoperative bronchoscopy
Preoperative management
Patient evaluation
System | Considerations |
---|---|
Airway |
|
Neurologic | |
Cardiovascular |
|
Pulmonary |
|
Gastrointestinal | |
Hematologic | |
Renal | Foley, monitor urine output |
Endocrine | |
Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Standard ASA monitors: ECG, pulse oximetry, non-invasive blood pressure, capnography.
Induction and airway management
Preoxygenation, followed by intubation
Positioning
Supine, often with shoulder roll(especially if done under rigid bronchoscopy)
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
- Transfer to ICU for close observation.
- Patients often extubated on post-op day 5-7
- Continuous respiratory and hemodynamic monitoring.
- Assess for airway patency and adequacy of ventilation, often requiring multiple bronchoscopies for monitoring and visualization of anastomotic integrity
Pain management
- Adequate analgesia using minimal opioids, NSAIDs, and local anesthetic techniques.
- Avoid excessive coughing or strain to protect the anastomosis.
- Non-narcotic pain management are encouraged to prevent postoperative nausea, leading to vomiting, neck hyperextension, and potential aspiration.
Potential complications
- Anastomotic dehiscence or restenosis
- Most commonly cacused by tension on the anastamotic line.
- Airway obstruction
- Laryngeal edema.
- Hemorrhage, can be lifethreatening via tracheoinnominate fistula when anterior anastomosis has become dehiscent
- Infection
- Recurrent laryngeal nerve injury causing hoarseness or airway compromise
- Tracheoesophageal fistula (rare)
Procedure variants
Variant 1 | Variant 2 | |
---|---|---|
Unique considerations | ||
Indications | ||
Position | ||
Surgical time | ||
EBL | ||
Postoperative disposition | ||
Pain management | ||
Potential complications |