Supraglottic airway devices (SADs) may have advantages over endotracheal intubation for tracheal resection and reconstruction in cases of severe and proximally located subglottic stenosis. This retrospective case series examines the feasibility of using SADs as a novel approach to airway management in tracheal resections.
All patients who were managed with SADs for cervical tracheal resection and reconstruction during the study period (2010–2015) in our university hospital were included.
To examine the feasibility of airway management with SADs for tracheal resection, medical records were obtained from our institution’s electronic database and reviewed.
SADs were used in 10 patients who had extensive tracheal stenosis and a high prevalence of severe comorbidities. SAD insertion and subsequent positive pressure ventilation were successful in all patients, although 1 patient with preoperative respiratory failure had persistent hypercarbia. During the phase of resection and reconstruction, high-frequency jet ventilation was used to ensure adequate oxygenation. There were no intraoperative complications related to anesthetic management, apart from transient hypercarbia during and after jet ventilation. Most patients (n = 6; 60%) had an uneventful postoperative course. In this high-risk cohort, postoperative complications (ie, vocal cord edema, postoperative hemorrhage, pneumonia) occurred in 4 patients (40%).
This retrospective case series demonstrates the feasibility of using supraglottic airways alongside high-frequency jet ventilation for airway management in at least some cases of cervical tracheal resection and reconstruction. However, the small number of cases examined limits conclusions regarding indications, contraindications, and periprocedural safety.
From the Departments of *Anesthesiology and Intensive Care Medicine
†Thoracic Surgery, Medical Centre Cologne-Merheim, University Witten/Herdecke, Cologne, Germany.
Published ahead of print December 29, 2017.
Accepted for publication November 13, 2017.
The authors declare no conflicts of interest.
Patient consent: Requirement waived by institutional review board.
Ethics approval: Approval by institutional review board of the University Hospital Witten/Herdecke, Medical Center Cologne-Merheim, Board supervisor: Professor Maune.
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Address correspondence to Mark Schieren, MD, Department of Anesthesiology and Intensive Care Medicine, Medical Centre Cologne, University Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany. Address e-mail to firstname.lastname@example.org.