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Anesthetic management of patients with tracheal T‐tubes
Author(s) -
WOOTTEN CHRISTOPHER T.,
RUTTER MICHAEL J.,
DICKSON JOHN M.,
SAMUELS PAUL J.
Publication year - 2009
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2009.02957.x
Subject(s) - medicine , tracheal tube , tracheotomy , airway management , airway , anesthetic , tracheal intubation , anesthesia , perioperative , surgery , intubation
Summary Aims: To better inform the preoperative anesthesia assessment, we review the rationale of tracheal T‐tubes and the maintenance they require. We then describe specific intraoperative techniques to administer inhalational agents and maintain respiration in patients with tracheal T‐tubes. Background: Tracheal T‐tubes maintain airway patency in the healing phases of laryngotracheal reconstruction or in the setting of extrinsic or intrinsic airway collapse. The T‐tube comprises a superior limb, an inferior limb, and an anterior limb projecting from a tracheotomy site. Negotiating tracheal T‐tubes may present significant anesthetic challenges in both elective and emergent circumstances. Methods: The intraoperative ventilation techniques in patients with tracheal T‐tubes are reviewed as well as pre and postoperative T‐tube maintenance strategies. Results: Twelve techniques to connect anesthetic circuitry to tracheal T‐tubes in different perioperative clinical scenarios are detailed. Conclusions: T‐tubes are a well‐established method for supporting the airway in both adults and children. However, the very design of the T‐tube poses unique anesthetic management issues before, during, and after the operation. Anesthetic administration and gas exchange may be effectively achieved through a variety of methods, which we describe in detail.