Anesthesia for Tracheal Resection: A New Technique of Airway Management in a Patient with Severe Stenosis of the Midtrachea

Abstract

We report the combined use of a Fogarty catheter (FC), a 3.5-mm fiberoptic bronchoscope (FOB), and a 6.0 endotracheal tube (ETT) to intubate the lower trachea of a patient with a primary upper- and midtracheal tumor causing a 66% stenosis of the tracheal lumen at the level of the thoracic inlet. Initially, the 6.0 ETT, with the FOB and the FC fed to its tip, was placed above the tumor and rotated 90° counterclockwise. The FOB and the FC were advanced through the stenosis, and the FC cuff was inflated just above the carina. The ETT was advanced over the FOB toward the FC cuff, and the ETT cuff was inflated below the tumor and above the FC cuff. After inspection for blood and tumor debris through the FOB’s eyepiece, the FC cuff was deflated, both the FOB and FC were withdrawn, and intermittent positive pressure ventilation (IPPV) was begun.