Abstract
Purpose
Laryngo-tracheal stenosis remains a major complication after prolonged intubation or tracheostomy. Surgical resection with end-to-end anastomosis carries the best long term prognosis. For the anaesthetist, however, this procedure represents a most challenging situation.
Methods
Since 1993, we have used high frequency jet ventilation (HFJV) for tracheal resection. This paper describes the technique and the results of our series including 7 adults and 10 children.
Results
There were no adverse haemodynamic or ventilatory consequences due to HFJV. Oxygenation was well maintained during the HFJV period. Sixteen of the 17 patients had a good outcome. Despite the good result of the resection-anastomosis, one child still suffers from an associated posterior glottic stenosis.
Conclusion
Since the introduction of HFJV for surgery of tracheal stenosis in our institution no complication of this ventilatory technique has occured. It reduces the manipulation of the ventilation system and the period of apnea, thus decreasing the risk of hypoxaemia. The good access to the surgical field contributes to the success of resection-anastomoses in laryngo-tracheal stenosis.
Résumé
Objectif
La sténose laryngo-trachéale constitue une complication majeure de l’intubation prolongée et de la trachéostomie. Sa résection chirurgicale avec anastomose termino-terminale procure le meilleur pronostic à long terme. Cependant, cette l’intervention représente pour l’anesthésiste un défi de taille.
Méthodes
Depuis 1993. nous avons utilisé la ventilation par jet à haute fréquence (VJHF) pour la résection trachéale. Cet article en décrit la technique et nos résultats sur une série de sept adultes et de dix enfants.
Résultats
La VJHF n’a provoqué aucune conséquence hémodynamique ou ventilatoire défavorable. L’oxygénation s’est maintenue pendant la période de VJHF Seize des 17 patients ont connu une évolution heureuse. Malgré les bons résultats de la résection-anastomose, un enfant est toujours affligé d’une sténose postérieure de la glotte.
Conclusion
Depuis l’introduction dans notre institution de la VJHF pour la chirurgie de la sténose trachéale, nous n’avons déploré aucune complication due à cette technique de ventilation. Elle réduit les manipulations de l’appareil respiratoire et la période d’apnée et ainsi le risque d’hypoxémie. La facilité d’accès au champ opératoire contribue aux succès de la résection et de l’anastomose dans la sténose laryngo-trachéale.
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Magnusson, L., Lang, F.J.W., Monnier, P. et al. Anaesthesia for tracheal resection: report of 17 cases. Can J Anaesth 44, 1282–1285 (1997). https://doi.org/10.1007/BF03012777
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DOI: https://doi.org/10.1007/BF03012777