Gracias Este documento de Powerpoint contiene la imágen que ha solicitado Aviso de derechos reservados de autor Todos los materiales del servicio online,

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1 Gracias Este documento de Powerpoint contiene la imágen que ha solicitado Aviso de derechos reservados de autor Todos los materiales del servicio online, incluyendo, sin limitación, texto, imágenes, gráficos y otros archivos y la selección y el arreglo de esto, son materiales con derechos de autor de Ovid o de sus licenciadores, todos los derechos reservados. A excepción del uso autorizado especificado arriba, usted no puede copiar, modificar o distribuir los materiales del servicio online. Usted no puede reflejar ningún material contenido en este servicio online o en cualquier otro servidor. Cualquier uso no autorizado de cualquier material contenido en este servicio online puede violar leyes de Derechos de Autor, las leyes de marca registrada, las leyes de privacidad y publicidad y las regulaciones y los estatutos de las comunicaciones.

2 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.2 Table 1. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Table 1. Conditions Producing Signs and Symptoms of Tracheal Stenosis

3 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.3 Figure 1. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Figure 1. Pathology specimen of a benign tracheal stricture. Note the concentric stenosis and the small diameter of the remaining airway in the excised specimen. From Grillo HC.8aWith permission.

4 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.4 Figure 2. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Figure 2. Pathology specimen of a tracheal tumor. The specimen is oriented vertically and has been incised anteriorly and opened. The cartilages of six tracheal rings can be appreciated on the right side of the picture. From Grillo HC.8bWith permission.

5 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.5 Figure 3. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Figure 3. Pressure vs volume curve for the high volume low pressure cuff of a 7.5-mm outside diameter endotracheal tube. Squares show the pressure generated by overinflating the cuff free of any constraints. The circles show pressures generated by overinflating the cuff after it had been placed inside a 22-mm inside diameter hard plastic tube.

6 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.6 Table 2. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Table 2. Contradictions to Tracheal Resection and Reconstruction

7 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.7 Table 3. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Table 3. Special Equipment That Should Always Be Available for Tracheal Resection and Reconstruction

8 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.8 Figure 4. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Figure 4. Schematic representation of a trachea with (A) low and (B) high strictures. Most strictures are in the mid-to low region, where an endotracheal tube cuff would lie. (A) Most can be approached by intubation above the lesion with the cuff lying between the vocal cords and the lesion. (B) For high lesions, including those involving the distal larynx, intubation past the lesion (sometimes preceded by rigid bronchoscopy and dilation) is required.

9 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.9 Figure 5. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Figure 5. Ventilatory management of the open airway. In all cases, the open trachea is shown after resection of the lesion. (A) In the technique employed for the vast majority of cases, the oral endotracheal tube (ETT) is pulled back so that the lesion can be easily manipulated, but the cuff is left inflated to protect the airway from above. Intubation of the distal airway is accomplished across the field using sterile equipment. (B) The same arrangement is shown as applied to a low tracheal lesion, with endobronchial intubation. This technique can be used for most low tracheal and carinal resections. (C) Endobronchial ventilation is shown using a jet ventilation catheter placed through the oral ETT. (D) A high tracheal lesion with the oral ETT cuff deflated and the tube pulled back into the larynx is shown. If necessary for surgical exposure, the oral ETT can be removed entirely and the patient reintubated by a retrograde technique. In A, B, and D, ventilation may be intermittent, with the sterile cross-field ETT placed in the airway or moved aside by the surgeon as needed.

10 © 2000 Lippincott Williams & Wilkins, Inc. Publicado por Lippincott Williams & Wilkins, Inc.10 Figure 6. Anesthesia and Airway Management for Tracheal Resection and Reconstruction. Sandberg, Warren; MD, PhD International Anesthesiology Clinics. 38(1):55-75, Winter 2000. Figure 6. (A) Schematic diagram of the optimal oral and cross-field endotracheal tube (ETT positions). (B) For closure of the tracheal anastomosis, the ends of the trachea are approximated by sutures, and the oral ETT is positioned with its cuff distal to the suture line. Deliberate mainstem intubation may be required to accomplish this arrangement.