Francesco Paolo Caronia1, Domenico Loizzi2, Tommaso Nicolosi3, Sergio Castorina3, Alfonso Fiorelli4. 1. Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy. 2. Thoracic Surgery Unit, Università degli Studi di Foggia, Foggia, Italy. 3. Dipartimento di Chirurgia Toracica, Centro Clinico e Diagnostico Morgagni, Catania, Italy. 4. Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy.
Abstract
BACKGROUND: We reported a tubeless tracheal resection and reconstruction for the management of benign posttracheostomy tracheal stenosis. METHODS: A 34-year-old man with stridor, severe respiratory distress, and recurrent pneumonia was referred to our attention for treatment of benign posttracheostomy tracheal stenosis. As he refused general anesthesia, the procedure was performed while he was under local anesthesia and spontaneous ventilation. RESULTS: Sedation was started with infusion of dexmedetomidine 0.7 mg/kg/min and of remifentanil 0.5 mg/kg/h; also, 40%-50% oxygen was delivered using a laryngeal mask at a rate of 3.5 mL/min. An additional dose of 2% lidocaine was injected into the surgical site during the operation to achieve an adequate level of anesthesia. A standard resection and reconstruction of trachea was carried out and no recurrence was found in the follow-up of 41 months. CONCLUSION: Tubeless tracheal surgery seems to be a feasible and safe procedure. Larger prospective series should validate our results.
BACKGROUND: We reported a tubeless tracheal resection and reconstruction for the management of benign posttracheostomy tracheal stenosis. METHODS: A 34-year-old man with stridor, severe respiratory distress, and recurrent pneumonia was referred to our attention for treatment of benign posttracheostomy tracheal stenosis. As he refused general anesthesia, the procedure was performed while he was under local anesthesia and spontaneous ventilation. RESULTS: Sedation was started with infusion of dexmedetomidine 0.7 mg/kg/min and of remifentanil 0.5 mg/kg/h; also, 40%-50% oxygen was delivered using a laryngeal mask at a rate of 3.5 mL/min. An additional dose of 2% lidocaine was injected into the surgical site during the operation to achieve an adequate level of anesthesia. A standard resection and reconstruction of trachea was carried out and no recurrence was found in the follow-up of 41 months. CONCLUSION: Tubeless tracheal surgery seems to be a feasible and safe procedure. Larger prospective series should validate our results.