Anesthesia for tracheoplasty in a patient with tracheal stenosis: a case report

BACKGROUND: Tracheal stenosis is a serious complication often following prolonged endotracheal intubation. Surgical tracheoplasty is definitive treatment but poses significant airway management challenges during anesthesia, especially in patients with severe stenosis and comorbidities like coronary artery disease. CASE PRESENTATION: We present a 28-year-old male patient scheduled for tracheoplasty due to severe upper tracheal stenosis (narrowest diameter ~ 4 mm) following cardiac arrest and prolonged intubation. He also had pre-existing coronary artery disease (moderate stenosis). Traditional airway management (endotracheal tube, laryngeal mask, tracheostomy) was deemed unsafe. Anesthesia was achieved using bilateral superficial cervical plexus blocks and bilateral vagus nerve blocks under ultrasound guidance, supplemented with dexmedetomidine sedation and minimal sufentanil analgesia. Spontaneous respiration was preserved throughout the procedure. Proximal tracheotomy allowed local oxygen insufflation during resection and anastomosis. The surgery was completed successfully without extracorporeal circulation support. CONCLUSIONS: For patients undergoing tracheoplasty with critical stenosis and comorbidities, an awake, spontaneously breathing technique utilizing regional anesthesia blocks (superficial cervical plexus and vagus nerve) combined with targeted sedation/analgesia can provide a relatively safe and effective alternative to general anesthesia with endotracheal intubation or extracorporeal support. Meticulous planning and expertise in airway management and regional anesthesia are crucial.