Airway stent placement for direct cricothyroid membrane puncture anesthesia with airway stricture or fistula.

Abstract

Tracheal stent implantation with bronchoscope has become one of the main methods for the treatment of airway stenosis. Bronchoscopy is usually performed under local or general anesthesia. The aim of this study is to report our experience with direct cricothyroid membrane puncture anesthesia for airway stent placement. The medical records of 48 consecutive patients who underwent direct cricothyroid membrane puncture anesthesia for tracheal or bronchial stent placement were reviewed. The puncture site was chosen as the interspace between the thyroid cartilage and cricoid cartilage. Through the cricothyroid membrane, lidocaine was injected into the trachea to suppress the cough reflex. The airway stent was placed fluoroscopically at 48 patients at the trachea or bronchus. The success rate and complications of cricothyroid membrane puncture anesthesia were assessed. Anesthesia was successfully performed in all 48 patients. Six patients needed 2-4 mL supplementary lidocaine by injection from the catheter or stent delivery system. Technical success of the stent insertion was achieved in all 48 cases. Small asymptomatic subcutaneous hemorrhage occurred at the puncture site in two patients, which disappeared 1 or 2 days after stent placement. Direct cricothyroid membrane puncture anesthesia for airway metal stent insertion is safe and effective.