Analysis Of Anesthetic Management For 5 Cases Of Operations Of Tracheal Tumor Resection And Trachea Reconstruction

Objective: The anesthetic management for tracheal tumor resection and trachea reconstruction is complicated and highly risked. It will be investigated it in the article.Methods: Retrospective analysis of anesthetic management was conducted in 5 cases undergoing tracheal tumor resection and trachea reconstruction in the anesthetic unit, the fourth hospital of Hebei Medical University during 2007.3-2010.3. There was 1 case in the upside, 2 cases in the middle,1 case in the downside , 1 case in the end of the trachea invading the carina and right bronchia. They all came to the hospital because of chest depressed and dyspnea .One of them can't lay freely. The complications of hypertension and falling sickness were controlled well and the pre-operation examinations were not bad. ECG,SpO2,PaO2 were built by the routine when they entered the operating room, blood gas analysis was done when the operation needed. Midazolam and atropine were given to the patients by the vein. Anesthesia was induced with fentanyl-propofol-rocuronium or succinylcholine, then they were all oratracheal intubated . After considering the instance of the patients, the position,size,character of the tumor, endotracheal tubes made by ourselves of 2 cases were inserted above the tumor, then a new intubation were finished after opening the trachea; strengthen tubes of 3 cases were inserted below the tumor, two of them built a new intubation and one of them used high-frequency ventilation. All of them used high-frequency ventilation when the tracheal was broke. Anesthesia was maintained with isoflurane,remifentanil or propofol,remifentanil combined with atracurium. During the operation, we controlled the breath time and again, attracted the secretion in time, and adjust the parameter of the breath. The SpO2 of 1 case decreased to below 90%, but recovered to normal level after our management. The operation style of the patients included 4 cases of resection of tracheal tumor+end-to-end anastomosis of left stem trachea and 1 case of resection of trachea carinoma and carina+air passage reconstructing. The tracheal tubes were removed when the patients were aware and their breath came back well.Results: All the patients were sent to thoracic intensive care unit safely. There were no complications associated with anesthesia and all the patients returned home after resuming well.Conclusion: Meticulous anesthetic induction and ventilation management, knowledge of various anesthetic techniques, and good communication and cooperation between anesthetists and surgeons can improve the anesthetic safety.