Anaesthetic management of montgomery T-tube insertion for subglottic stenosis

Abstract

Objective To discuss the anaesthetic management of Montgomery T-tube insertion for subglottic stenosis. Methods The data including characteristics, clinical features, anaesthetic methods, operation procedures and postoperative recovery of 20 patients with subglottic stenosis underwent Montgomery T-tube insertion were reviewed and analyzed. Results The causes of stenosis were tracheal intubation (12 cases), tracheal trauma (four cases), internal and external tracheal tumors (three cases). On the degree of stenosis, there was one case of Myer-Cotton grade Ⅰ, three cases of grade Ⅱ, nine cases of grade Ⅲ, seven cases of grade Ⅳ.Bronchoscopic examination showed tracheal collapse in nine cases.All patients were tracheotomized before operation and used a rigid bronchoscope as working channel during operation.All patients were anaesthetized with total intravenous anaesthesia.The anaesthesia of all patients was stable, and ventilation modes were alternated smoothly.Postoperative complications such as cough (80%), sore throat (45%), fever (45%), difficulty in sputum evacuation (40%), difficulty breathing (25%), infection (10%), airway obstruction (5%), aspiration (5%) were cured after active treatment. Conclusions During montgomery T-tube insertion for subglottic stenosis, total intravenous anaesthesia can ensure depth of anaesthesia and stability of circulatory parameters.Controlled ventilation or high frequency ventilation by tracheotomy tube, T-tube, and laryngeal mask on demand can ensure oxygen supply.Communication closely during perioperation and active treatment of postoperative complications are beneficial for the safety and the recovery of patients. Key words: Acquired subglottic stenosis; Tracheal T-tube; Anesthesia