Anästhesie und Chirurgie der Trachea

Zusammenfassung

Ziel dieser Übersichtsarbeit ist es, einen Überblick über das aktuelle anästhesiologische Management von Trachearesektionen zu geben.

Neben dem „traditionellen“ anästhesiologischen Vorgehen, bei dem nach der Einleitung der Allgemeinanästhesie eine konventionelle endotracheale Intubation erfolgt und nach chirurgischer Eröffnung der Trachea eine Cross-Field-Intubation oder Jet-Ventilation durchgeführt wird, gibt es einen Trend zu weniger invasiven anästhesiologischen Verfahren. Regionalanästhesiologische Techniken, die auf den Erhalt der Spontanatmung abzielen, werden zunehmend beschrieben. Insbesondere für zervikale Trachealpathologien scheinen Larynxmasken vorteilhafte Alternativen zur endotrachealen Intubation zu sein.

Extrakorporale Verfahren können einen suffizienten Gasaustausch und/oder eine adäquate Perfusion während komplexer Resektionen und Rekonstruktionen gewährleisten, ohne dass die Atemwegshilfsmittel das operative Feld beeinträchtigen. Sie stellen zudem eine effektive Rückfallebene dar, falls andere Verfahren zur Oxygenierung versagen.

Das Spektrum der verfügbaren anästhesiologischen Techniken für operative Eingriffe an der Trachea ist immens. Um den sichersten Ansatz für den individuellen Patienten zu finden, ist eine interdisziplinäre Evaluation unerlässlich. Die Lokalisation und die Beschaffenheit der Atemwegspathologie, Begleiterkrankungen, der funktionelle Zustand des respiratorischen Systems sowie die geplante rekonstruktive Technik müssen berücksichtigt werden.

Bis mehr Daten verfügbar sind, ist ein evidenzbasierter Vergleich unterschiedlicher Verfahren nicht möglich.

Abstract

This article aims to review the current anaesthetic management of tracheal resections.

Apart from the “traditional” approach of induction of general anaesthesia with conventional tracheal intubation and cross-field intubation or jet ventilation during the resection phase, there has lately been a trend towards less invasive techniques.

Regional anaesthesia, laryngeal mask airways and preservation of spontaneous ventilation are among the new anaesthetic approaches. Current data suggest potential advantages compared with conventional tracheal intubation.

Extracorporeal membrane oxygenation may provide adequate gas exchange and/or cardiovascular support for complex resections and reconstructions. In addition, it may serve as a reliable “backup” technique, in case of oxygenation difficulties with the use of other devices.

Given the vast spectrum of different anaesthetic approaches to tracheal surgery, interdisciplinary planning is essential to identify the optimal technique on a case-by-case basis. During that process, the localisation and consistency of the airway lesion, comorbidities and the functional status of the respiratory system and specific surgical approach need to be taken into account.

As there is a lack of high-quality data, evidence-based comparisons of different anaesthetic techniques are not possible.

Schlüsselwörter

Thoraxanästhesie - Atemwegsmanagement - Trachealstenose - nicht intubiert - Larynxmaske

Keywords

thoracic anesthesia - airway management - tracheal stenosis - non-intubated - laryngeal mask airway

Publication History

Received: 06 October 2023

Accepted after revision: 14 November 2023

Article published online:
20 December 2023

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