Anaesthesia for surgery of the trachea and main bronchi

The anaesthetic challenges of major tracheobronchial surgery relate to airway control, ventilation management, maintaining optimal surgical exposure and appropriate patient selection. Although such surgery is generally performed in specialist centres, the strategies for dealing with central airway obstruction and bronchoscopy under general anaesthesia are of broader importance. Furthermore, an intra-thoracic airway obstruction presents difficulties that require a different mindset to the more familiar scenario of an extra-thoracic airway obstruction. Tracheal stenosis following a period of prolonged tracheal intubation is now the leading indication for tracheal resection. A standard approach involves total intravenous anaesthesia, a right-sided arterial line, epidural analgesia and early extubation. Usually, a sterile armoured cuffed endotracheal tube is placed under direct surgical vision for the period of segmental resection followed by reintroduction of the native orotracheal tube under bronchoscopic vision for the primary end-to-end anastomotic reconstruction.