Fresh T-tube insertion with novel tracheostomy under pure local anesthesia maneuver for critical middle tracheal stenosis

Technique

This technique introduces an innovative maneuver for fresh T-tube insertion performed under pure local anesthesia to treat critical middle tracheal stenosis with natural voice preservation. This approach spares the need for a previous tracheostomy, thus providing a plausible option for patients who were prohibited general anesthesia due to severe cardiovascular issues. A 72-year-old male with severe tracheal stenosis superimposed with poor cardiac function underwent T-tube insertion simultaneously following laser ablation. A 0.6 cm round shape stoma exposed the trachea lumen, allowing argon plasma ablation of fibrotic narrowing. The T-tube was then inserted assisted by tracheal dilator to restore airway patency, enabling immediate breathing recovery.

Result

The procedure was completed successfully with orchestrate maneuver. Immediate postoperative results showed significant improvements in the patient's breathing, with no need for intubation or intravenous (IV) general anesthesia. The patient was discharged within a week and resumed normal activities, indicating the effectiveness and safety of this approach.

Conclusions

This innovative method offers a viable approach for extremely high-risk patients for general anesthesia, ensuring efficient airway management and rapid recovery.