Intubation for Anesthesia

Many patients will already have a tracheostomy tube in place either in the damaged segment or below it. This stoma is used for induction and maintenance of anesthesia by placing a flexible endotracheal tube through it, as described in Chapter 18, "Anesthesia for Tracheal Surgery." In the absence of a preexisting tracheostomy, I prefer not to dilate a tightly stenotic laryngeal airway any more than is absolutely necessary, in order to avoid producing sufficient trauma in the larynx to make repair difficult and, also, to contribute to postoperative laryngeal edema. After minimal dilation, an uncuffed endotracheal tube of small diameter (5.5 or 6 mm ID) is passed to provide safe ventilation in the early phases of dissection. The tightness of stricture provides a seal for the tube. Tight stenosis is encountered more often with circumferential subglottic stenosis than with anterolateral stenosis. Once the trachea is transected below the lesion and a distal airway is established, the proximal endotracheal tube is withdrawn. In these patients, where repair will be intralaryn-geal, I prefer to withdraw the translaryngeal tube completely, rather than suture a catheter to it. Even a small catheter crowds the tiny operative field. An endotracheal tube is replaced later, as described below.

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