Anesthetic management of patients with tracheal T-tubes

Summary Aims: To better inform the preoperative anesthesia assessment, we review the rationale of tracheal T-tubes and the maintenance they require. We then describe specific intraoperative techniques to administer inhalational agents and maintain respiration in patients with tracheal T-tubes. Background: Tracheal T-tubes maintain airway patency in the healing phases of laryngotracheal reconstruction or in the setting of extrinsic or intrinsic airway collapse. The T-tube comprises a superior limb, an inferior limb, and an anterior limb projecting from a tracheotomy site. Negotiating tracheal T-tubes may present significant anesthetic challenges in both elective and emergent circumstances. Methods: The intraoperative ventilation techniques in patients with tracheal T-tubes are reviewed as well as pre and postoperative T-tube maintenance strategies. Results: Twelve techniques to connect anesthetic circuitry to tracheal T-tubes in different perioperative clinical scenarios are detailed. Conclusions: T-tubes are a well-established method for supporting the airway in both adults and children. However, the very design of the T-tube poses unique anesthetic management issues before, during, and after the operation. Anesthetic administration and gas exchange may be effectively achieved through a variety of methods, which we describe in detail.