Anaesthesia for tracheal and airway surgery

Major surgery on the trachea and airway is an anaesthetic challenge which necessitates the simultaneous control of the airway, maintenance of gas exchange and good surgical exposure. Advance planning, good communication and teamwork among surgeon, anaesthetist and theatre nurses are never more important. This is one of the few areas of surgery where the management of the airway is shared at times between the anaesthetist and surgeon. A major indication for laryngeal and tracheal surgery is laryngotracheal stenosis, a rare condition which can cause significant morbidity and life-threatening airway obstruction. In the era of modern medicine, post-intubation injury has superseded infection and external trauma as the commonest aetiology. The incidence of post-intubation stenosis has been estimated at 4.9 cases per million per year. Definitive surgery is usually carried out in tertiary specialist centres; the surgical technique depends on the site and pathological process. Segmental resection of the trachea with primary end-to-end anastomotic reconstruction has demonstrated a high level of successful decannulation and is usually the technique of choice for tracheal stenosis.