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Resection of Stenotic Trachea

A Case Presentation

C. PAUL BOYAN, M.D.^*, and PAUL A. PRIVITERA, CRNA

*Professor and Chairman, Department of Anesthesiology, Medical College of Virginia. Virginia Commonwealth University, Richmond, Virginia 23298. Clinical Director, School for Nurse Anesthetists, Allied Health Professions. Virginia Commonwealth University, Richmond, Virginia 23298.

Abstract

Tracheal stenosis is usually a complication of prolonged mechanical ventilation. If the narrowing is severe it will greatly obstruct the air flow. Resection of the damaged trachea is a life saving procedure. The anesthetic management of the resection of an "ice cream cone narrowing" of the trachea (3 mm diameter) 4 cm above the carina is reported. A forced vital capacity loop (expiration-inspiration) of air flow versus volume revealed preoperatively little difference in the flow during the forced (F-V) and resting ventilation (Vt), thus confirming a diagnosis of severe upper airway obstruction. A total obstruction of the air flow was encountered during the skeletonization of the trachea and the surgeon was allowed to work for not more than 60 seconds at a time. Perfect cooperation between the surgeon and the anesthesia team is necessary for the successful completion of this type of surgery.