ABSTRACT
UNLABELLED: Tracheal and bronchial endoscopic stenting can give a quick therapeutic result or delay surgiCal treatment of patients with stenosis. It also can improve quality of life, create conditions for palliative therapy and increase survival of incur- able oncological patients. This paper contains description of our experience in anesthesia for tracheal stenting with re- spiratory support. MATERIALS AND METHODS: 23 patients were investigated retrospectively (15 males, 8females). They had 28 interventions under general anesthesia. 14 patients had malignant and 9 had non-malignant lesions. Complicated somatic status, stenosis extention and localization, type of laryngoscope. unprotected airways determined choice of in- travenous anesthesia with high-frequency ventilation and muscle relaxation. RESULTS: Improvement (dyspnea decreasing) was mentioned in 78,3% (18/23) cases after stenting, in 8,7% (2/23) cases improvement was slight; in 4,3% (1/23) cases - no change; in 8,7% (2/23) cases patients died complications after stenting occurred in 10 cases (43,5%). In 4 cases (17,4%) - stent displacement; in 2 cases (8,7%) - purulent tracheobronchitis; in 1 case (4,35%) - paroxysmal cough with pain. In 1 case loss of stent during paroxysmal cough and vocal cords edema occurred. In 2 cases (8,7%) operation was failed and patients died due to the lesion progression and respiratory insufficiency. CONCLUSIONS: Anesthetic pro- tection is an important component at endoscopic recanalization with selfexpanded stents. Management is difficult due to complicated somatic status, and unprotected airways. Significant health enhancement, dyspnea decreasing even by exercise stress justified high anesthetics risks.
Subject(s)
Airway Obstruction/therapy , Anesthesia/methods , Laryngoscopy/methods , Stents , Tracheal Stenosis/therapy , Adult , Aged , Airway Obstruction/etiology , Female , Humans , Male , Middle Aged , Respiration, Artificial , Tracheal Stenosis/etiology , Treatment Outcome , Young AdultABSTRACT
Esophagectomy with simultaneous plasty in patient with esophageal cancer is still associated with a high incidence of postoperative complications and long-stay patient in the clinic. The purpose of our report is to inform the use of the program of accelerated rehabilitation after esophagectomy in a prospective study of 13 patients during the period from 2010 to 2011 year and the role of the anesthesiologist in its implementation. Methods aimed at the preoperative examination, minimally invasive surgery, thoracic epidural anesthesia/analgesia with local anesthetics as a component of anesthesia and postoperative analgesia, early extubation and mobilization of the patient with the implementation of breathing exercises, early enteral feeding, and the planned short postoperative stay in resuscitation and hospital were used. Postoperative complications were observed in 3 (23/1%) patients: one patient (7/7%) had right-side pneumonia, two patients (15/4%) had right-side pneumothorax requiring emergency re drainage. The average intensive care stay was 2 (1-4) days, postoperative hospital stay--9 (7-12) days. Further monitoring of the patients did not show any long-term complications. The results confirm that it is possible to optimize the healing perioperative process in patients after esophagectomy with simultaneous plasty by using of accelerated rehabilitation program without the risk of increasing the frequency of postoperative complications. it will provide the reduction of length of hospital stay. In view of multifaceted and controversial issue the following researches in this direction are necessary.
Subject(s)
Esophageal Neoplasms/surgery , Esophagectomy/rehabilitation , Esophagoplasty/rehabilitation , Postoperative Care/methods , Postoperative Complications/rehabilitation , Adult , Aged , Esophageal Neoplasms/rehabilitation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Postintubation tracheal ruptures is a rare but serious complication with high risk for the patient's life. The preliminary diagnosis is usually made after occurrence of subcutaneous emphysema, blood spitting, respiratory insufficiency, pneumothorax and/or pneumomediastinum. The suspected rupture of the trachea should be verified by fiber-optic bronchoscopy. The decision about necessity of surgical or conservative treatment is based on the compilation of clinical, radiologic and endoscopic data. We present 9 cases (7 women and 2 men) of postintubation tracheal ruptures, occurred during the esophageal (6), lung (2) and mammary gland (1) surgery.
