Realtime evaluation of the tracheal blood flow with use of laser doppler flowmeter during operation for the esoghageal cancer wit radical lymph nodes dissection

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It is important to preserve the blood supply to the trachea during the operation for the esophageal cancer with radical lymph nodes dissecton of the upper mediastinum. In this study, the change of the tracheal blood flow (TBF) was measured with use of laser doppler flowmeter (LDF) during the operation. Materials and Methods ; The change of TBF of 21 patients was measured with LDF during the general surgery and that of three dogs was measured during the radical lymph nodes dissection of the upper mediastinum with ligature of the bronchial arteries. The sensor of the LDF was fixed to the endotracheal cuff and attached to the tracheal mucosa of the membranous wall. Results ; TBF which measured with LDF decreased when the tracheal cuff pressure rose and increased when it fell. LDF made rapid responce to the change of TBF.During the arteficial respiration, TBF increased by expiration and decreased by inspiration. TBF increased when blood pressure rose rapidly and decreased when it fell. TBF increased by raising of the legs and the arms, by using of pneumatic tourniquet and by the pneumoperitoneum. It decreased by static oppression of the trachea at the neck. During the dissection of the upper mediastinum of the dogs, TBF decreased after the ligature of the intercostobronchial arteries and the bronchial arteries arising from the aorta. After the resection of the tracheal proper seaths, TBF did not changed. Disscusion ; LDF could measure the rapid change of TBF and had the possibility to be useful as the anesthetic monitor system. We reported the anatomy of the bronchial arteries before this study and described that they course through the tracheal proper sheath to the trachea. The present study support it from the view of the blood flow, and preserving the bronchial arteries and the tracheal proper sheath is important during the upper medaistinum dissection.