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Canadian Journal of Anesthesia, Vol 46, 1178-1180, Copyright © 1999 by Canadian Anesthesiologists' Society

ARTICLES

Airway management of a child after tracheal resection

N Burt, MM Pruner and AR Williams
Department of Anesthesia & Perioperative Medicine, Children's Hospital, Charleston, South Carolina 29425, USA. burtn@musc.edu

PURPOSE: To report a strategy for minimizing airway risks and optimizing airway management in the post-reanastomosis phase of the anesthetic management of a patient undergoing tracheal reconstruction. CLINICAL FEATURES: A 14-yr-old boy with squamous cell carcinoma of his trachea underwent a tracheal resection and end-to-end reanastomosis for removal of tumour. This procedure was accomplished through a right thoracotomy. A thoracic epidural had been placed before induction of anesthesia through which 3 mg morphine and 10 ml bupivacaine 0.25% with epinephrine were administered during surgery. After chest wall closure the patient was allowed to recover spontaneous respiration and the trachea was extubated during deep anesthesia to eliminate airway response with coughing which might have stressed the anastomosis. An infusion of bupivacaine 0.0625% and morphine (100 microg x ml(-1)) was maintained until the third postoperative day. The patient had an unremarkable postoperative course and was discharged on the eighth postoperative day. CONCLUSION: In this case thoracic epidural analgesia and tracheal extubation during deep anesthesia was a safe and effective strategy for minimizing airway risks and optimizing airway management in after the reanastomosis phase of tracheal resection.




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Copyright © 1999 by the Canadian Anesthesiologists' Society.