piperidines and Tracheal-Stenosis

The use of monitored anaesthesia care (MAC) is necessary and ubiquitous for fiberoptic bronchoscopy. Anaesthetic management of patients with severe tracheal stenosis has always been a challenge. The efficacy and safety of the MAC with sufentanil target controlled infusion (TCI) and remifentanil TCI in patients with severe tracheal stenosis are still unknown.. This study is a prospective, investigator-initiated, two-arm, randomised control trial to compare the efficacy and safety of sufentanil TCI with remifentanil TCI in patients with severe tracheal stenosis undergoing fiberoptic bronchoscopy. 270 patients will be randomly assigned to the sufentanil TCI group or remifentanil TCI group, with a 1:1 ratio in two groups. The primary outcome is the incidence of hypoxaemia (an oxygen saturation of <90%). The secondary outcome investigates the severity of hypoxaemia, cough severity, haemodynamic variables, sedation scores and satisfaction scores.. The study has been approved by the Medical Ethics Committee of Shanghai Pulmonary Hospital (approval No. K19-122). The results will be submitted for publication in peer-reviewed journals.. ChiCTR2100043380.

Topics: Anesthesia; Bronchoscopy; China; Humans; Hypoxia; Piperidines; Prospective Studies; Randomized Controlled Trials as Topic; Remifentanil; Sufentanil; Tracheal Stenosis

Maintaining spontaneous ventilation (SV) under total intravenous anesthesia (TIVA) without an endotracheal tube provides uninterrupted and unobstructed surgical access for suspension microlaryngoscopy (SML). This study describes the method and outcome of adults who underwent SML under tubeless TIVA-SV.. Retrospective review of adults who underwent SML between June 2014 and September 2016 using TIVA-SV without an endotracheal tube.. Sixty-six cases in 36 patients were included with mean age of 50.6 years and 52.7% were female. Airway pathology included 41.6% subglottic or tracheal stenosis, 19.4% laryngeal lesion or mass, 16.7% glottic stenosis, 13.9% recurrent respiratory papilloma, and 8.3% supraglottic stenosis. Anesthesia was most commonly provided by continuous infusion of propofol and remifentanil (57.6%). Approximately half (53%) of cases received superior laryngeal nerve block. Average operative time was 72.9 minutes (range, 27-166 minutes). Eight cases required supplemental ventilation: 6 cases required transient endotracheal ventilation or mask ventilation, and 2 cases were converted to alternative ventilation.. Total intravenous anesthesia is an attractive alternative to traditional endotracheal tube intubation, jet ventilation, or intermittent apneic ventilation for adult SML. During episodes of hypoventilation or desaturation, endotracheal ventilation, mask ventilation, or jet ventilation can effectively recover oxygenation.

Topics: Adult; Aged; Anesthesia, Intravenous; Anesthetics, Intravenous; Female; Humans; Intubation, Intratracheal; Laryngeal Diseases; Laryngoscopes; Laryngoscopy; Male; Middle Aged; Miniaturization; Operative Time; Piperidines; Remifentanil; Respiration; Retrospective Studies; Tracheal Stenosis; Treatment Outcome

The need to compromise between surgical and anesthetic access in airway surgery is an important clinical problem. We wanted to determine the feasibility of performing upper airway surgery under awake anesthesia and spontaneous respiration.. This was a prospective, clinical feasibility study. Patients with upper tracheal stenosis were managed through cervical epidural anesthesia and conscious sedation, and atomized local anesthetic. No intraoperative intubation or jet ventilation was required. Outcome measures were ease of surgery, observer-rated functional result, early (less than 30 days) complications, and patient-reported satisfaction.. Twenty consecutive patients with idiopathic (n = 4) or postintubation (n = 16) complete (n = 3) or severe (>80%, n = 17) subglottic (n = 12) or upper trachea (n = 8) stenosis were enrolled. Operations included 12 subglottic and 8 segmental resections with primary anastomosis. Permissive hypercapnia was well tolerated. Median length of resection was 4.5 cm (range, 2 to 6 cm), and 12 releases (8 thyrohyoid, 4 suprahyoid) were required. One patient required a nasotracheal tube for 36 hours. All but 1 were able to cough and talk immediately, and to swallow fluids and solids, and were fully mobilized at 6 hours. There were no early complications. Median hospitalization was 3.1 days (range, 2 to 15). Patients had excellent (n = 16) or good (n = 4) functional (n = 20) outcomes, with no early relapse of stenosis. Median self-reported satisfaction at median 12 months was 9.5 +/- 1.0 (scale, 0 to 10). All patients indicated that they would be happy to repeat the procedure.. Awake and tubeless upper airway surgery is feasible and safe, and has a high level of patient satisfaction. If supported by randomized controlled trial, this method will change the way airway stenosis surgery is approached by both surgeons and anesthesiologist.

Topics: Adult; Aerosols; Analgesics, Opioid; Anastomosis, Surgical; Anesthesia, Epidural; Anesthetics, Local; Conscious Sedation; Early Ambulation; Feasibility Studies; Female; Follow-Up Studies; High-Frequency Jet Ventilation; Humans; Intubation, Intratracheal; Larynx; Length of Stay; Lidocaine; Male; Middle Aged; Patient Satisfaction; Piperidines; Postoperative Complications; Prospective Studies; Remifentanil; Trachea; Tracheal Stenosis

We report that spontaneous breathing under total intravenous anesthesia by 0.1 microg x kg(-1) x hr(-1) of remifentanil and 3 mg x kg(-1) x hr(-1) of propoforl can be maintained during the surgery for tracheobronchial stent insertion in a man with severe trachea stenosis. Remifentanil is an ultra-short acting narcotic, and is excellent for relieving pain maintaining stable hemodynamics. As this drug is used at a low dose, it is suitable for this case which requires a short time of operation, minimally invasive surgery, prevention of moving, and the spontaneous breathing. We could achieve steady respiratory and hemodynamic control.

Topics: Aged; Anesthesia, Intravenous; Bronchoscopes; Humans; Male; Piperidines; Propofol; Remifentanil; Respiration; Respiratory Insufficiency; Severity of Illness Index; Stents; Tracheal Stenosis

To report the use of propofol and remifentanil infusions to facilitate smooth extubation of a surgically resected airway.. A 19-yr-old man weighing 85 kg was scheduled for tracheal resection surgery following postintubation tracheal stenosis. He had a relatively long segment (4 cm) of his trachea resected and anastomosed. Postoperatively, he was sedated and electively ventilated for four days in a chin to chest position by stay sutures. In order to reduce any risk of traumatic disruption to the tracheal anastomosis, we planned to extubate his trachea under light general anesthesia. Attempts to extubate his trachea using propofol and alfentanil infusions failed. We used propofol and remifentanil infusions to achieve a state of sedate cooperation and extubated his trachea with fibreoptic bronchoscope guidance.. Propofol and remifentanil infusions in combination can facilitate successful extubation of the surgically resected airway with high risk of disruption.

Topics: Adult; Analgesics, Opioid; Anastomosis, Surgical; Anesthetics, Intravenous; Blood Pressure; Bronchoscopes; Conscious Sedation; Fiber Optic Technology; Heart Rate; Humans; Infusions, Intravenous; Intubation, Intratracheal; Male; Oxygen; Piperidines; Propofol; Remifentanil; Respiration, Artificial; Tracheal Stenosis

To report a case of lower respiratory tract obstruction occurring in a patient with primary pulmonary amyloidosis and discuss anesthetic management.. A 53-yr-old man was referred to our institution for microlaryngoscopy and laser treatment of the larynx. He presented with a five-year history of primary laryngo-tracheo-bronchial amyloidosis and symptoms consistent with narrowing of the conducting airways. General anesthesia was induced with iv propofol 150 mg and remifentanil 50 microg. Mivacurium 20 mg provided muscle relaxation for endotracheal intubation. Following endotracheal intubation, the airway became obstructed and patient ventilation impossible. The endotracheal tube was removed and a Dedo laryngoscope inserted. Gas exchange was maintained using supraglottic jet ventilation via a distal port of the laryngoscope. Rigid bronchoscopy showed tissue partially obstructing the lumen of the lower trachea. This was removed and the airway appeared patent. At the end of the case, a further episode of lower airway obstruction occurred requiring reinsertion of the laryngoscope and resumption of jet ventilation. Extensive debridement through the bronchoscope was required before adequate ventilation could be restored. Some days later when the patient's condition deteriorated again and he required further debridement of the trachea and insertion of a tracheostomy, guide wires were positioned in the femoral vessels in the event that cardiopulmonary bypass was required for gas exchange.. Primary laryngo-tracheo-bronchial amyloidosis is a recurrent disease, requiring repetitive surgical procedures. Airway compromise can be a persistent problem. Awareness of this uncommon disease process and its presentation may serve to caution the anesthesiologist presented with this type of case.

Topics: Amyloidosis; Anesthesia, General; Anesthetics, Intravenous; Bronchial Diseases; High-Frequency Jet Ventilation; Humans; Intubation, Intratracheal; Isoquinolines; Laryngoscopy; Laryngostenosis; Lung Diseases; Male; Middle Aged; Mivacurium; Neuromuscular Nondepolarizing Agents; Piperidines; Propofol; Remifentanil; Reoperation; Respiratory Tract Diseases; Tracheal Stenosis