Anesthetic management of tracheal stent extraction using a double gum elastic bougie technique

Satoshi Sato,Takayuki Onaka,Tomohiro Chaki,Michiaki Yamakage

doi:10.1186/s40981-022-00500-z

Abstract

BackgroundTracheal stenosis is a life-threatening condition, and management of a patient with a risk of tracheal stenosis is challenging for anesthesiologists. In this report, we describe a method for airway management using two gum elastic bougie method when removing a tracheal stent via a tracheostomy orifice with a risk of airway restenosis.Case presentationA 71-year-old man had an enlarged squamous cell carcinoma of the lung invading the upper mediastinum that had caused severe stenosis of the trachea. Two months after diagnosis, a tracheal stent had been placed to maintain tracheal patency. One month after stent placement, acute respiratory failure was induced by upper airway obstruction caused by subglottic airway edema due to mechanical stimulation of the cranial end of the stent, and the patient was rescued by oral tracheal intubation. Tracheal stent extraction was scheduled to relieve the laryngeal edema. Since there was a risk of tracheal restenosis because of the possibility of accidental evulsion of the orally tracheal tube which intubated to secure an emergency airway and tracheal stent extraction, two gum elastic bougies were inserted through the oral tracheal tube and tracheostomy orifice to facilitate re-intubation. After extraction of the tracheal stent, airway openness was maintained and tracheostomy was completed without any complication.ConclusionSuccessful management of tracheal stent extraction was performed using a double gum elastic bougie technique.

Highlights

Tracheal stenosis is a life-threatening condition, and management of a patient with a risk of tracheal stenosis is challenging for anesthesiologists
Tracheal stent placement is indicated for patients who have airway stenosis of 50% or more and a risk of asphyxia [1]
The tracheostomy technique using a bougie has been used to ensure the safety of surgical emergency airway management in the field of emergency medicine [7]

Summary

Background

Tracheal stent placement is indicated for patients who have airway stenosis of 50% or more and a risk of asphyxia [1]. The safety and efficacy of oral tracheal tube replacement using a bougie to maintain airway integrity have been reported [6]. There have been only a few reports on anesthetic management of a patient who had a tracheal stent removed via a tracheostomy orifice [8]. We report our novel method for airway management by maintaining a route for oral and transtracheal reintubation using two bougie tubes during tracheal stent removal with a risk of restenosis. Acute hypoxia associated with airway obstruction in the hospital ward, the patient presented with acute respiratory failure and was rescued by oral tracheal intubation. Two airway risks were considered preoperatively: the risk of airway restenosis due to accidental removal of the tracheal intubation tube and the risk of the trachea being restenotic after tracheal stent extraction due to bleeding from the tumor or release of pressure drainage. Four hours after the operation, the patient had the tracheostomy cannula removed, and his respiratory and circulatory status remained stable

Discussion

Findings

Funding Not applicable