BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of...BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.展开更多
The trachea is an anatomical structure of 10–12 cm of length in adults,which could appear just a simple conduit that brings the air to the lungs,but it is a very complex organ with a lot of functions and is supplied ...The trachea is an anatomical structure of 10–12 cm of length in adults,which could appear just a simple conduit that brings the air to the lungs,but it is a very complex organ with a lot of functions and is supplied by many arterial branches arising from inferior thyroid artery,bronchial,intercostal arteries or direct branches from descending aorta,that create a vascular reticulum entering inside and feeding the ciliated pseudostratified columnar epithelium.The literature search has been made by using keywords“Tracheal tumors”,“Trachea surgery”,“Carina surgery”,“Engineered trachea”.We selected 74 articles from 15,191 papers.According to the literature search,we can say that,because of its own structure,it’s not simple to resect and reconstruct the trachea by direct end-to-end anastomosis,especially for more than 50%of its length and it cannot be easily replaced or transplanted.Although surgery is not the only possible therapy,the radiotherapy and the endoscopic treatments are so far from guarantee an adequate survival,and they are usually employed as adjuvant therapies after surgery or they are reserved to non-surgical patients for medical problems or oncological criteria.To overcome the surgical limits in direct reconstruction,have been developed different autogenic or allogenic grafts and nowadays there are different vascularized biocompatible scaffolds till the tissue engineered neotrachea,but more studies are still needed to standardize a valid reconstructive system for tracheal major resections or transplantation.展开更多
BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath.The clinical symptoms of tracheal schwannoma depend on the location of the tumor,and the most common clinical symptoms are cough and...BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath.The clinical symptoms of tracheal schwannoma depend on the location of the tumor,and the most common clinical symptoms are cough and hemoptysis.The most effective treatment for benign tumors is complete resection of the primary lesion at an early stage.Our experience has demonstrated that primary tracheal schwannoma can be safely excised with a high-frequency electric knife in a minimally invasive manner.CASE SUMMARY We report a 61-year-old asymptomatic woman who underwent chest computed tomography(CT),which accidentally found an intraluminal tracheal mass without enlarged lymph nodes.Then,the patient underwent bronchoscopy,which found that the tracheal mass originated from the left wall of the upper trachea,was less than 1.5 cm in size,immovable,smooth and 4 cm away from the vocal cord,resulting in partial upper respiratory tract obstruction.Treatment was performed using an endoscopic resection for en bloc removal of the tracheal mass.The diagnosis was primary tracheal schwannoma.A follow-up was performed after endoscopic surgery,and bronchoscopy and thoracic CT were used to monitor whether there was a recurrence.At present,there is no evidence of recurrence,and the patient had a good quality of life.Endoscopic resection may be effective and safe in the treatment of primary tracheal schwannoma.CONCLUSION Primary tracheal schwannoma is a very rare benign tumor.In this case,we cured it by complete endoscopic resection.展开更多
文摘BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.
文摘The trachea is an anatomical structure of 10–12 cm of length in adults,which could appear just a simple conduit that brings the air to the lungs,but it is a very complex organ with a lot of functions and is supplied by many arterial branches arising from inferior thyroid artery,bronchial,intercostal arteries or direct branches from descending aorta,that create a vascular reticulum entering inside and feeding the ciliated pseudostratified columnar epithelium.The literature search has been made by using keywords“Tracheal tumors”,“Trachea surgery”,“Carina surgery”,“Engineered trachea”.We selected 74 articles from 15,191 papers.According to the literature search,we can say that,because of its own structure,it’s not simple to resect and reconstruct the trachea by direct end-to-end anastomosis,especially for more than 50%of its length and it cannot be easily replaced or transplanted.Although surgery is not the only possible therapy,the radiotherapy and the endoscopic treatments are so far from guarantee an adequate survival,and they are usually employed as adjuvant therapies after surgery or they are reserved to non-surgical patients for medical problems or oncological criteria.To overcome the surgical limits in direct reconstruction,have been developed different autogenic or allogenic grafts and nowadays there are different vascularized biocompatible scaffolds till the tissue engineered neotrachea,but more studies are still needed to standardize a valid reconstructive system for tracheal major resections or transplantation.
文摘BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath.The clinical symptoms of tracheal schwannoma depend on the location of the tumor,and the most common clinical symptoms are cough and hemoptysis.The most effective treatment for benign tumors is complete resection of the primary lesion at an early stage.Our experience has demonstrated that primary tracheal schwannoma can be safely excised with a high-frequency electric knife in a minimally invasive manner.CASE SUMMARY We report a 61-year-old asymptomatic woman who underwent chest computed tomography(CT),which accidentally found an intraluminal tracheal mass without enlarged lymph nodes.Then,the patient underwent bronchoscopy,which found that the tracheal mass originated from the left wall of the upper trachea,was less than 1.5 cm in size,immovable,smooth and 4 cm away from the vocal cord,resulting in partial upper respiratory tract obstruction.Treatment was performed using an endoscopic resection for en bloc removal of the tracheal mass.The diagnosis was primary tracheal schwannoma.A follow-up was performed after endoscopic surgery,and bronchoscopy and thoracic CT were used to monitor whether there was a recurrence.At present,there is no evidence of recurrence,and the patient had a good quality of life.Endoscopic resection may be effective and safe in the treatment of primary tracheal schwannoma.CONCLUSION Primary tracheal schwannoma is a very rare benign tumor.In this case,we cured it by complete endoscopic resection.
