Anesthesia and gas exchange in tracheal surgery

Tracheobronchial surgery constitutes a challenge to the anesthetist because it involves the anatomic structures dedicated to bulk gas transport. Common approaches to airway management and gas exchange for extrathoracic and intrathoracic airway surgery are reviewed, with due regard to less common methods thought crucial for specific procedures. Tracheal surgery, beyond sharing the airways, requires sharing with the surgeon ideas on preoperative assessment, on the impact on gas exchange of induction across compromised airways, and of emergence from anesthesia with airways altered by surgical repair. Mutual understanding is essential to prevent, rapidly identify, and correct imminent loss of airway viability.