Resection of tracheal tumours and tracheal reconstruction under spontaneous breathing anaesthesia with a simple and practical intraoperative ventilation technique: a case report

Tracheal tumours can be resected under spontaneous breathing anaesthesia (SBA) with cross-field endotracheal intubation. However, given the intermittent ventilation interruption during the anastomotic process, more convenient alternatives are being explored. In this context, our centre presents a case of tracheal tumour resection and reconstruction (TRR) involving a simple and practical intraoperative ventilation technique. A 49-year-old man was admitted to our hospital and presented with pharyngeal discomfort and difficulty breathing for half a year. After discussion among a multidisciplinary team, to relieve symptoms, resection of the tumour and cervical tracheal reconstruction were performed under spontaneous breathing anaesthesia. During the surgical process, a thin suction tube [outer diameter (OD) 3.33 mm; 10 Fr] was inserted into the distal cervical trachea. Then, 100% oxygen was continuously administered, and the fresh gas flow was set within a range of 5–10 L/min to maintain the SpO2 above 90%. Additionally, high-frequency jet ventilation (HFJV) was performed as a rescue approach if the SpO2 was less than 90%. Satisfactory oxygenation was achieved throughout the anastomotic process, and owing to the small diameter of the suction tube, the surgical process was smooth and without incident. The patient was discharged on postoperative Day 8, and no obvious complications were observed at the one-month follow-up. This case illustrates a simple and practical intraoperative ventilation technique using a suction tube with a small diameter for perioperative airway management during TRR, which could provide satisfactory oxygenation and facilitate the surgical process.