Anaesthesia for surgery of the trachea and main bronchi

Major tracheobronchial surgery has many anaesthetic challenges. These include airway management, one lung ventilation, maintaining optimal surgical exposure, and appropriate patient selection. Tracheobronchial surgery is typically performed in specialist centres, yet the strategies for dealing with central airway obstruction and bronchoscopy under general anaesthesia are of broader importance. An intra-thoracic airway obstruction presents difficulties different from those of an extra-thoracic airway obstruction as positive pressure ventilation can cause distal gas trapping and volutrauma. Sharing the airway with the surgical team requires good communication and teamwork, along with knowledge of techniques to manage emergency situations. Preoperative assessment of the patient with airway obstruction can provide a guide as to the challenges likely to be encountered. Thought must also be given to the possible palliative nature of the procedure. This article describes anaesthetic techniques for bronchoscopy with airway stenting, laser therapy, inhaled foreign body, and tracheal and carinal resection.