Purpose: To review the literature on tracheal and carinal resection and reconstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The airway management is extensively reviewed.
Source: Articles obtained from a Medline search (1960 to October 1997; keywords: tracheal surgery, carinal surgery, airway management). Textbook literature including the bibliographies were also consulted.
Principal findings: Benign or malignant tracheal and carinal pathology causing obstruction can be managed in several ways but resection and reconstruction are the treatment of choice for most patients with tracheal stenosis or tumour. Surgery of the trachea is a special endeavour where the airway is shared by the surgeon and the anesthesiologist. The principal anesthetic consideration is ventilation and oxygenation in the face of an open airway. Ventilation can be managed in different ways, including manual oxygen jet ventilation, high frequency jet ventilation, distal tracheal intubation, spontaneous ventilation, and cardiopulmonary bypass.
Conclusion: The management of anesthesia for tracheal surgery presents many challenges to the anesthesiologist. Knowledge of the various techniques for airway management is crucial. Meticulous planning and communication between the anesthesia and surgical teams are mandatory for the safe and successful outcome of surgery for patients undergoing this procedure.