Anesthetic Management of Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis Involving a Sequential Airway Strategy.

A postintubation tracheal stenotic patient who requires surgical resection and anastomosis is a challenging case for an anesthesiologist, requiring meticulous planning during surgical correction due to a shared airway. This case report is about the anesthetic management of a 23-year-old male who developed severe tracheal stenosis following prolonged mechanical ventilation after decompressive craniectomy and presented with severe dyspnea, wheeze, and stridor five weeks later. Tracheal resection and anastomosis were the ultimate solution for this patient. For that, a sequential airway strategy was used. This strategy includes distal tracheal intubation under bilateral superficial cervical plexus block, along with conscious sedation, followed by general anesthesia with cross-field ventilation, bronchoscopy-guided resection, and intermittent apneic technique during anastomosis. The patient was extubated at the table, and total recovery was uneventful. This case demonstrates the successful application of a sequential airway strategy, which facilitates safe tracheal surgery and immediate extubation.