The anesthesia, per-and post-operative management for tracheal reconstruction in children

During the past 3 years, we experienced 15 cases of anesthesia for new method of tracheal reconstruction. These new method had been included next 4 kind of operations, (1) implantation of short cartilage graft for subglottic stenosis (6 cases), (2) implantation of long cartilage graft for congenital total tracheal stenosis (3 cases), (3) implantation of silastic reinforced marlex mesh for tracheobronchialmalacia (5 cases), and (4) carinal resection for carina tumor (1 case). In these operations, there had been following 4 extremely difficult probrems, (1) how to ensure the airway tract, (2) how to ventilate effectively during operations, (3) how long to ventilate with ventilator and (4) the period of tracheal intubation during the postoperative managment. For the perioperative problems (1, 2) we tried tracheal or broncheal intubation from the operative field and in this time the patients had become hypercapnia (PaCO2 80 torr ↑). Therefor, high frequency jet ventilation (HFJV) or extra corporeal membranous oxygenation (ECMO) may be more effective method for these operations. For the post-operative problems (3, 4), we think that it is nessesary for 4 weeks or more tracheal intubation and artificial ventilation. Bronchoscopy was the most effective to observe the airway tract after operations.