The application of tubeless anesthesia technique in tracheal tumor resection surgery: a case report

Systemic hemangioma after neoadjuvant immunotherapy for hypopharyngeal carcinoma is one of the common complications of neoadjuvant immunotherapy. Its pathogenesis may be related to multiple immune regulatory imbalances and vascular biological changes. This case was a locally advanced hypopharyngeal cancer patient who received neoadjuvant immunotherapy and total laryngectomy with partial hypopharyngectomy. During follow-up, a mass was found in the middle part of the trachea, protruding into the tracheal lumen. The peculiarity of this case was that the tracheal mass was located in the middle part of the trachea, with a narrow lumen. During anesthesia, whether the tracheal intubation was placed above or below the mass would affect the operation. After multidisciplinary team discussion, a no-intubation anesthesia plan was adopted, using esketamine, which could maintain spontaneous breathing well, ensure sufficient depth of anesthesia, and reduce the occurrence of bronchospasm. The airway management mainly used high-flow nasal cannula to provide a large flow and flow rate, prolonging the safe period without breathing and oxygenation, providing a safety guarantee for the operation and ensuring its successful completion.