Carcinoma Trachea for Tracheal Resection and Anastomosis

Tracheal resection and reconstruction is a relatively rare surgery and the need to share the compromised airway with the surgeon makes it more challenging. Preoperative assessment, clinical symptoms, and investigations play a vital role in assessing the level and intensity of stenosis. Proper planning for induction (keeping in mind the tracheal pathology) with backup plan is needed. Different methods of ventilation including distal tracheal intubation with IPPV for high and mid tracheal surgery and one lung ventilation for carinal surgery can be considered. Coordination with the surgeon during airway excision and anastomosis, and management of emergence are most critical steps. Postoperative care is equally important including maintenance of neck flexion, assessment of tracheal bleed and obstruction, laryngeal edema, and vocal cord dysfunction which makes it unique.