Anesthetic management of tracheal tumor resection with preservation of spontaneous breathing under laryngeal mask airway general anesthesia combined with epidural anesthesia

喉罩通气下保留自主呼吸的气管肿瘤切除术的麻醉管理:全身麻醉联合硬膜外麻醉

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Abstract

Surgical management of tracheal tumors presents a dual challenge: optimizing respiratory function while ensuring complete tumor resection. This requires the formulation of an individualized anesthetic plan, specifically tailored to the tumor's location and the surgical approach employed. Surgical management of tracheal tumors presents a dual challenge: optimizing respiratory function while ensuring complete tumor resection. This requires the formulation of an individualized anesthetic plan, specifically tailored to the tumor's location and the surgical approach employed. BACKGROUND: Tracheal resection and reconstruction is considered the gold standard for the treatment of tracheal tumors. However, anesthetic choices may be influenced by the tumor's histopathological characteristics, growth pattern, anatomical localization, degree of airway obstruction, and the selected surgical approach. Traditionally, general anesthesia with endotracheal intubation is performed to facilitate respiratory control. In certain extreme cases, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB) may be necessary to ensure patient safety. This case presents a more suitable anesthetic approach that not only reduces trauma to the patient, ensuring safety, but also lowers medical costs, shortens recovery time, and aligns with the principles of Enhanced Recovery After Surgery (ERAS), making it an optimal choice for both routine and more severe tracheal tumor patients. CASE PRESENTATION: A 22-year-old Asian female presented with a history of dyspnea lasting for more than two months. Upon fiberoptic bronchoscopy, a lesion in the middle segment of the trachea was identified, and partial resection of the tumor was performed during the procedure. Approximately two weeks later, the patient underwent surgical treatment under preservation of spontaneous breathing with laryngeal mask airway general anesthesia combined with epidural anesthesia. The patient was successfully discharged on the fourth postoperative day. CONCLUSIONS: This case presents an anesthetic management approach for tracheal tumor resection, which, while ensuring anesthetic safety, utilizes preservation of spontaneous breathing with laryngeal mask airway general anesthesia combined with epidural anesthesia. This approach not only reduces medical costs and minimizes patient harm but also promotes recovery. For future patients with similar or more severe conditions, this anesthetic method may be a more favorable option to consider. KEY WORDS: case report;tracheal tumour;epidural anesthesia;general anesthesia;spontaneous breathing.

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