title: Low tracheal tumor and airway management: An anesthetic challenge.
abstract: We describe a case presenting with tracheal tumor wherein a Microlaryngeal tube was advanced into the trachea distal to the tumor for primary airway control followed by cannulation of both endobronchial lumen with 5.5 mm endotracheal tubes to provide independent lung ventilation post tracheal transection using Y- connector attached to anesthesia machine. The plan was formulated to provide maximal surgical access to the trachea while providing adequate ventilation at the same time. A 32 yrs non smoker male, complaining of cough, progressive dyspnea and hemoptysis was diagnosed to have a broad based mass in the trachea on computed tomography of chest. Bronchoscopy of the upper airway confirmed presence of the mass at a distance of 9 cms from the vocal cords, obstructing the tracheal lumen by three fourth of the diameter. The patient was scheduled to undergo the resection of the mass through anterolateral thoracotomy. We recommend the use of extralong, soft, small sized microlaryngeal surgery tube in tumors proximal to carina, for securing the airway before the transection of trachea and bilateral endobronchial intubation with small sized cuffed endotracheal tubes for maintenance of ventilation after the transection of trachea in patients with mass in the lower trachea.
authors.affiliation: Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Richa
authors.initials: R
authors.lastname: Saroa
authors.affiliation: Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Satinder
authors.initials: S
authors.lastname: Gombar
authors.affiliation: Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Palta
authors.affiliation: Department of Surgery, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Dalal
authors.affiliation: Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Varinder
authors.initials: V
authors.lastname: Saini
keywords: Anesthetic management; Microlaryngeal Tube; tracheal tumour