Anaesthesia and tracheobronchial stenting for central airway obstruction in adults

Abstract

In the last decade, stents suitable for the management of tracheobronchial stenoses and obstruction have evolved from bulky prostheses requiring tracheal resection to small devices that are self-expanding and can be inserted using fibreoptic techniques. The experience base for this review is more than 100 patients between 1989 and 2001 who have been anaesthetized for stent insertion. Early cases required rigid bronchoscopy for the routine of insertion. Anaesthetic techniques have evolved from those that were designed and developed for laser surgery in the central airways. The advent of modern devices now extends the variety of anaesthetic management techniques that can be used. But the original one, based on the requirement for use of a rigid bronchoscope, is best for dealing with complications and extracting problem stents. The most frequent complication of the processes of stent insertion has been respiratory failure because of carbon dioxide retention, consequent on obstruction with secretions in the area of the carina. The nature of central airway problems suggests that anaesthesia induction, management and teaching should not be founded on the conventional model-base of upper airway obstruction.

Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis

“…In cases of non-life threatening airway obstructions, topical anesthesia of the pharynx and larynx, procedural sedation, or general anesthesia are routinely performed for stent placement (1)(2)(3)(4)(5). However, in patients with critical airway obstruction (nearly complete obstruction due to severe stricture and/or sputum), airway stent placement can be extremely dangerous because the airway collapse limits the ability to oxygenate and ventilate during interventional procedures despite ventilation support (6)(7)(8).…”

Obstruction of the right stem bronchus due to ovarian local metastasis: a 5-year follow-up

“…Moreover; rigid bronchoscopy is more efficient in such situations (18)(19)(20). It is very important that these procedures take place in centers with experience in order to avoid laceration of the airways, tracheobronchial wall and main vessels damage (21). SEMS are either silicon-covered, made of nickel titanium alloy or without cover.…”

Automatic administration of propofol and remifentanil guided by the bispectral index during rigid bronchoscopic procedures: a randomized trial

“…15 In daily use, the number of target modifications would probably have been lower than during the study, and this bias benefits the control group. As suggested by Conacher, 1 we replaced succinylcholine with mivacurium. It is of great interest to emphasize that succinylcholine could interfere with the anesthetic management because initial myoclonus and later reappearance of muscle activity could be responsible for an Manual TCI = manual target-control infusion of propofol and remifentanil guided by the bispectral index; Dual-loop = automated control of propofol and remifentanil guided by the bispectral index Duration of induction: time elapsed from the start of propofol administration until the moment when the BIS value decreased to and remained \ 60 for [ 30 seconds Manual TCI = manual target-control infusion of propofol and remifentanil guided by the bispectral index; Dual-loop = automated control of propofol and remifentanil guided by the bispectral index increase in electromyographic activity as this signal overlaps the BIS algorithm's beta ratio in the 30-47-Hz range.…”