Abstract
<title>Abstract</title> <p>Tracheal tumors are rare respiratory neoplasms, and severe tracheal stenosis caused by these lesions presents substantial challenges for intraoperative airway management. This report describes the anesthetic management of a 58-year-old female patient with a malignant tracheal tumor complicated by eccentric tracheal stenosis who underwent tracheal tumor resection and tracheoplasty. The patient presented with intermittent cough, dyspnea, and blood-tinged sputum, and preoperative chest CT revealed a tracheal mass with severe eccentric stenosis (minimum lumen diameter: 3 mm). Considering the high risk of conventional endotracheal intubation, we adopted a combined strategy of ultrasound-guided cervical nerve block + vagus nerve block with low-dose sedative and analgesic agents to maintain spontaneous breathing throughout the operation. Before tracheal transection, a laryngeal mask airway was placed for intraoperative ventilation. After the diseased tracheal segment was resected, oxygen was insufflated directly into the proximal tracheal stump to maintain oxygenation. The patient was awakened for cooperative positioning during tracheal anastomosis, no severe airway complications or hemodynamic instability occurred intraoperatively. The total operative time was 210 min, and the duration of anesthesia was 240 min. The patient recovered fully postoperatively and was transferred to the ward safely. This case report verifies the safety and feasibility of the combined strategy involving nerve block with sedation and its ability to promote the preservation of spontaneous breathing for tracheoplasty in patients with severe tracheal stenosis. For patients with critical airway stenosis caused by tracheal tumors, individualized anesthetic protocols involving multimode nerve block, preserving spontaneous breathing, and including comprehensive emergency backup plans can effectively ensure perioperative safety.</p>