Airway Management and Endoscopic Treatment of Subglottic and Tracheal Stenosis

Abstract

Objectives The objective is to present clinical outcomes of subglottic and tracheal stenosis treated by flexible bronchoscopic delivery of carbon dioxide (CO2) laser via laryngeal mask airway (LMA). Methods All consecutive, nontracheotomy dependent cases of subglottic and tracheal stenosis treated endoscopically over a 4-year period were retrospectively reviewed. The surgical approach consisted of radial incisions using a flexible fiber-based CO2 laser, balloon dilation, and topical application of mitomycin C. Ventilation during the procedure occurred through the LMA, and the CO2 laser fiber was delivered through the working channel of a flexible bronchoscope passed through the LMA. Number of dilations, period between dilations, and operative times were reviewed. Results Eleven patients who underwent airway intervention during the study period were identified. Average follow-up was 28 months. Etiologies of airway stenosis included intubation injury (6), idiopathic (4), or autoimmune disease (1), requiring an average of 1.3, 1.5, and 3 dilations, respectively. Average operative time was 67 minutes. Autoimmune etiology correlated with more frequent dilations. Conclusion LMA is an effective way to manage ventilation while simultaneously allowing unencumbered flexible bronchoscopic access for laser surgery, balloon dilation, and mitomycin C application for airway stenosis. Long-term success in treating stenosis is achievable using this technique.

Safety and efficacy of laryngeal mask airway ventilation in obese patients with airway stenosis

“…The LMA represents a useful tool in the management of patients with airway stenosis. It may be used to ventilate patients, whereas intervention is performed endoscopically or as part of the ventilation plan in open tracheal resection . Whereas the LMA has been shown to be an effective tool in the management of airway stenosis and in ventilation of the obese population, its use has not previously been reported in obese patients with stenotic airways.…”

“…The LMA has been in use for over 2 decades. There have been reports of successful use of the LMA for airway management in both endoscopic and open airway procedures . In some protocols, the LMA is the initial method of airway management in the treatment of the obese population .…”

Anaesthetic management of acute airway obstruction

“…(7,83,84) However, in head and neck surgery, due to the shared airway, a tracheal tube is usually indicated.…”

Difficult airway associated with bifid glottis and coexistent subglottic stenosis in a patient with Pallister–Hall syndrome: a case report

“…The most common cause of subglottic stenosis is prolonged endotracheal intubation [5]. There are numerous reports which describe airway management in patients with subglottic stenosis [6][7][8]. It is challenging for anesthesiologists to manage airways with subglottic stenosis that also have other airway abnormalities.…”