| A Case Report Anesthesia for Tracheostenosis . |
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Dal Sheup Pyeun, Hung Kun Oh, Seung Rok Hong |
1Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea.
2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. |
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| Abstract |
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A 32 year-old man was scheduled for tracheal reconstruction after having special radiological studies and pulmonary function tests. Atropine was given preoperatively. A radial artery cannula was inserted for blood gas sampling and direct arterial pressure monitoring. The E,K.G. was monitored continuously. With the patient breathing a high concentration of oxygen from a mask, halothane was added to the inspired gas. After intramuscular injection of ketamine, halothane was discontinued. Spontaneous respiration was preserved with assistance when necessary. The larynx, pharynx and trachea were topically anesthetized and then a large-bore rubben orotracheal tube was placed in the trachea above the lesion. Anesthesia was maintained with additional ketamine injection. The trachea was explored through an anterior transverse cervical incision with a median sternotomy. The segment distal to the obstruction as dissected and found to be maligant tissue extending down to near the carina and behind the aortic arch. So, it was imperative to postpone further the surgery. Immediately after skin closure, the trachea was almost completely obstructed and PaCO2 value was above 150 mmHg. Therefore the airway was preserved by a pediatric bronchoscope, which was replaced by a pediatric endotracheal tube. Anesthetic management and tracheal resection and reconstruetion have been reviewed problems of induction in a patient with tracheal obstruction are discussed, and the technics for retaining control of the airway and reducing the hazards of hypoxia and hypercarbia are also stressed. |
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