Interventional bronchoscopy for tracheal tumours: An anaesthetic challenge

Abstract

Tracheal tumours may present with potentially catastrophic airway obstruction. There are many challenges in the management of anaesthesia for obstructing intratracheal tumours by rigid bronchoscopy, such as difficulty in ventilation, securing airway, sharing of airway with the surgeon and control of seepage of blood and tumour tissues distally into the tracheobronchial tree during resection. We report a 58-year-old woman, known case of renal cell carcinoma for whom right nephrectomy was done, who presented with sudden respiratory distress. Computed tomography showed a polypoidal lesion measuring 8 mm anteroposteriorly and 9 mm transversely in the trachea with attachment at the 6 o'clock position just before the tracheal bifurcation obstructing 70%–80% of the lumen. The tumour was resected through a rigid bronchoscope using electrocautery and a polypectomy snare. Careful preoperative evaluation of the site and degree of obstruction, on-going communication between surgeon and anaesthesiologist, tailored anaesthetic management techniques and meticulous postoperative care can help to deal with the difficulties and complications associated with the management of these cases.