Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2022.02.001
Brazilian Journal of Anesthesiology
Original Investigation

Perioperative management of patients undergoing tracheal resection and reconstruction: a retrospective observational study

Manejo perioperatório de pacientes submetidos à ressecção e reconstrução traqueal: um estudo observacional retrospectivo

Juan C. Segura-Salguero; Lorena Díaz-Bohada; Álvaro J. Ruiz

Downloads: 0
Views: 174

Abstract

Background
Perioperative management of Tracheal Resection and Reconstruction (TRR) presents many challenges to the physicians involved in airway management. Factors related to postoperative outcomes can be identified as early as the preoperative setting and can even be linked to demographic characteristics of patients affected by tracheal stenosis. The primary aim of this study is to describe the experience of patients undergoing TRR at our hospital from an anesthesiology perspective, describing as a second aim demography, preoperative conditions, and postoperative complications.

Methods
This was a single institution retrospective review of patients who underwent TRR between 2009 and 2020. We did a post-hoc exploratory analysis to identify possible associations between perioperative complications and perioperative management.

Results
Forty-three ASA I–IV adult patients aged 18–72 years who underwent TRR were included. Prolonged intubation (72%) is the primary cause of tracheal stenosis. Intraoperative management: intravenous induction and laryngeal masks are now the most frequently used for airway management, especially in subglottic stenosis. Perioperative complications were vocal cord paralysis (25.6%), postoperative ventilatory support (20.9%), and need for surgical reintervention (20.9%). One patient (2%) died in the postoperative period due to anastomotic complication. After resection, dexmedetomidine is the preferred choice (48.8%) for sedoanalgesia in the ICU.

Conclusions
Perioperative management of TRR at our hospital has a low mortality and high morbidity rate. We did not find an association between perioperative anesthetic interventions and postoperative complications. Further studies are needed to evaluate which anesthetic interventions may be associated with better outcomes.

Keywords

Thoracic surgery;  Tracheal stenosis;  Airway management;  Anesthesia

Resumo

Justificativa: O manejo perioperatório da ressecção e reconstrução traqueal (RRT) apresenta muitos desafios para os médicos envolvidos no manejo das vias aéreas. Fatores relacionados aos resultados pós-operatórios podem ser identificados já no cenário pré-operatório e podem até mesmo estar ligados às características demográficas dos pacientes acometidos por estenose traqueal. O objetivo principal deste estudo é descrever a experiência dos pacientes submetidos à RRT em nosso hospital na perspectiva da anestesiologia, descrevendo como segundo objetivo a demografia, condições pré-operatórias e complicações pós-operatórias. Métodos: Esta foi uma revisão retrospectiva de uma única instituição de pacientes submetidos a RRT entre 2009 e 2020. Fizemos uma análise exploratória post-hoc para identificar possíveis associações entre complicações perioperatórias e manejo perioperatório. Resultados: Quarenta e três pacientes adultos ASA I-IV com idade entre 18 e 72 anos submetidos a RRT foram incluídos. A intubação prolongada (72%) é a principal causa de estenose traqueal. Manejo intraoperatório: a indução intravenosa e as máscaras laríngeas são hoje as mais utilizadas para o manejo das vias aéreas, especialmente na estenose subglótica. As complicações perioperatórias foram paralisia das cordas vocais (25,6%), suporte ventilatório pós-operatório (20,9%) e necessidade de reintervenção cirúrgica (20,9%). Um paciente (2%) faleceu no pós-operatório por complicação da anastomose. Após a ressecção, a dexmedetomidina é a escolha preferencial (48,8%) para sedoanalgesia na UTI. Conclusões: O manejo perioperatório da RRT em nosso hospital tem baixa mortalidade e alta morbidade. Não encontramos associação entre intervenções anestésicas perioperatórias e complicações pós-operatórias. Mais estudos são necessários para avaliar quais intervenções anestésicas podem estar associadas a melhores resultados.

Palavras-chave

Cirurgia toráxica; Estenose traqueal; Gestão das vias aéreas; Anestesia

References

1 IA Hobai, SV Chhangani, PH Alfille Anesthesia for tracheal resection and reconstruction Anesthesiol Clin, 30 (2012), pp. 709-730

2 CD Wright, HC Grillo, JC Wain, et al. Anastomotic complications after tracheal resection: Prognostic factors and management J Thorac Cardiovasc Surg, 128 (2004), pp. 731-739

3 CJ Mutrie, SM Eldaif, CW Rutledge, et al. Cervical tracheal resection: New lessons learned Ann Thorac Surg, 91 (2011), pp. 1101-1106

4 BJ Bibas, RM Terra, AL Oliveira Junior, et al. Predictors for postoperative complications after tracheal resection Ann Thorac Surg, 98 (2014), pp. 277-282

5 C Piazza, F Del Bon, A Paderno, et al. Complications after tracheal and cricotracheal resection and anastomosis for inflammatory and neoplastic stenoses Ann Otol Rhinol Laryngol, 123 (2014), pp. 798-804

6 M Schieren, E Egyed, B Hartmann, et al. Airway management by laryngeal mask airways for cervical tracheal resection and reconstruction: A single-center retrospective analysis Anesth Analg, 126 (2018), pp. 1257-1261

7 AM Smeltz, M Bhatia, H Arora, J Long, PA Kumar Anesthesia for resection and reconstruction of the trachea and carina J Cardiothorac Vasc Anesth, 34 (2020), pp. 1902-1913

8 Z Hatipoglu, M Turktan, A Avci The anesthesia of trachea and bronchus surgery J Thorac Dis, 8 (2016), pp. 3442-3451

9 M Krecmerova, J Schutzner, P Michalek, P Johnson, T Vymazal Laryngeal mask for airway management in open tracheal surgery – A retrospective analysis of 54 cases J Thorac Dis, 10 (2018), pp. 2567-2572

10 PE Roman, RJ Battafarano, AM Grigore Anesthesia for tracheal reconstruction and transplantation Curr Opin Anaesthesiol, 26 (2013), pp. 1-5

11 M Schieren, A Böhmer, F Dusse, A Koryllos, F Wappler, J Defosse New approaches to airway management in tracheal resections – A systematic review and meta-analysis J Cardiothorac Vasc Anesth, 31 (2017), pp. 1351-1358

12 K McRae Tracheal Resection and Reconstruction P Slinger, RS Blank, J Campos, J Lohser, K McRae (Eds.), Principles and Practice of Anesthesia for Thoracic Surgery (Second Edition), Springer, Switzerland (2019), pp. 231-248

13 CM Myer 3rd, DM O'Connor, RT Cotton Proposed grading system for subglottic stenosis based on endotracheal tube sizes Ann Otol Rhinol Laryngol, 103 (4 Pt 1) (1994), pp. 319-323

14 M Hentze, S Schytte, H Pilegaard, TE Klug Single-stage tracheal and cricotracheal segmental resection with end-to-end anastomosis: Outcome, complications, and risk factors Auris Nasus Larynx, 46 (2019), pp. 122-128

15 HA Gaissert, J Burns The compromised airway: Tumors, strictures, and tracheomalacia Surg Clin North Am, 90 (2010), pp. 1065-1089

16 C Pinsonneault, J Fortier, F Donati Tracheal resection and reconstruction Can J Anesth, 46 (5 Pt 1) (1999), pp. 439-455

17 SA Nouraei, DA Giussani, DJ Howard, GS Sandhu, C Ferguson, A Patel Physiological comparison of spontaneous and positive-pressure ventilation in laryngotracheal stenosis Br J Anaesth, 101 (2008), pp. 419-423

18 BC Shin, CH Lim, DH Kim, et al. Anesthetic management of tracheal reconstruction surgery with laryngeal mask airway: A case report Korean J Anesthesiol, 46 (2004), p. 620

19 K Okuda, R Nakanishi The non-intubated anesthesia for airway surgery J Thorac Dis, 8 (2016), pp. 3414-3419

20 H Liang, D Gonzalez-Rivas, Y Zhou, et al. Nonintubated anesthesia for tracheal/carinal resection and reconstruction Thorac Surg Clin, 30 (2020), pp. 83-90

21 P Macchiarini, I Rovira, S Ferrarello Awake upper airway surgery Ann Thorac Surg, 89 (2010), pp. 387-391

22 L Jiang, J Liu, D Gonzalez-Rivas, et al. Thoracoscopic surgery for tracheal and carinal resection and reconstruction under spontaneous ventilation J Thorac Cardiovasc Surg, 155 (2018), pp. 2746-2754

23 CH Lee, MJ Peng, CL Wu Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study Crit Care, 11 (2007), p. R72

24 TJ Gan, KG Belani, S Bergese, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting Anesth Analg, 131 (2020), pp. 411-448

25 H Cheng, JW Clymer, B Po-Han Chen, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis J Surg Res, 229 (2018), pp. 134-144

26 S Fiorelli, F Creazzola, D Massullo, et al. Dexmedetomidine sedation after tracheal surgery: A prospective pilot study Ann Thorac Surg, 108 (2019), pp. 256-261

27 D Mathisen Distal tracheal resection and reconstruction Thorac Surg Clin, 28 (2018), pp. 199-210

28 DK Mueller, J Becker, SK Schell, KM Karamchandani, JR Munns, B Jaquet An alternative method of neck flexion after tracheal resection Ann Thorac Surg, 78 (2004), pp. 720-721

29 HC Grillo, DM Donahue, DJ Mathisen, JC Wain, CD Wright Postintubation tracheal stenosis. Treatment and results J Thorac Cardiovasc Surg, 109 (1995), pp. 486-492

30 A Siciliani, EA Rendina, M Ibrahim State of the art in tracheal surgery: A brief literature review Multidiscip Respir Med, 13 (2018), p. 34

626fe0b1a95395192430a453 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections