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.
Background: The T-tube poses significant challenges for positive pressure ventilation.
Method: We describe the modification of a Foley catheter by trimming off the proximal urine drainage port, and using this opening to pass a metal stylet within the catheter, providing additional rigidity and allowing easier manipulation of the catheter tip. The catheter tip is then positioned in the superior limb of the T-tube, and the balloon inflated under direct visualization to occlude the opening and allow positive pressure ventilation through the external limb of the T-tube.
T-tubes and airway stents are commonly used but have limited effectiveness and frequent complications. A 50-year-old male patient presented with severe tracheal stenosis, affecting an 8.7 cm length of the airway.
Objective: The Montgomery T-tube is a commonly used device initially designed as a temporary airway stent, but also used as a long-term airway solution for stenosis. For patients undergoing either endoscopic or open airway procedures, proper techniques for inserting these tubes are well documented. This review compiles the techniques used for insertion of the Montgomery T-tube stent.
To analyze the efficacy and safety of Montgomery T-tube (T-tube) placement for benign complex subglottic tracheal stenosis. A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019. The causes were postintubation tracheal stenosis [27 cases (93.
To review the key points of the perioperative period management of laryngotracheoplasty using free hyoid grafting in children with acquired subglottic stenosis, in order to reduce postoperative complications, to improve extubation rate, and to promote the rehabilitation of the patients. Twenty-five cases with subglottic stenosis were treated by laryngotracheoplasty using free hyoid grafting in department of Otolaryngology, Head and Neck Surgery, Shanghai Children's Hospital from September 2017 to June 2021. Standardized perioperative period management protocols were carried out in all 25 cases.
