TRACHEAL STENOSIS SURGERY

AIRWAY MANAGEMENT

Abstract

Objective: To highlight the problems and solutions in airways management in patients with tracheal stenosis undergoing surgical interventions and to highlight the alternative methods of airway control where high frequency ventilatory facility is not available. Study Design: Case series study. Place and Duration: Combined Military Hospital Rawalpindi from 1st Jan 2004 to 30th June 2007. Patients and Methods: Twenty nine patients of both sex and all age groups presenting with difficulty in breathing due to tracheal stenosis undergoing surgical intervention on trachea have been included. All the patients were managed under general anaesthesia. Nasogastric tube 10 Fr, suction catheter, laryngeal mask airway or mask ventilation was used for initial ventilation where conventional endotracheal tube of even smallest size did not work. Results: Small size endotracheal tube were used in twenty four patients. Difficulty was faced in five patients. In these patients endotracheal tube of smallest size available could not be passed and we had to provide ventilation by innovative measures like nasogastric tube 10Fr in one, suction catheter 10Fr in two, laryngeal mask airway in one and mask ventilation in one. There was no mortality. Conclusions: Adequate ventilation during tracheal stenosis surgery can be very difficult in some cases. Therefore a thorough understanding, a tier of flexible plans and a variety of ventilating means should be arranged before administering anaesthesia.Nasogastric tube 10Fr or suction catheter of similar size are suitable alternative if facility for high frequency ventilation is not available.