Rapid Intravenous Induction of Anesthesia for Dilatation of Severe Post-Intubation Tracheal Stenosis with Rigid Bronchoscopy: Report of 100 Cases

Abstract

Background : Rigid bronchoscopic dilatation is the lifesaving method for management of severe tracheal stenosis which is carried out under general anesthesia. However, this procedure is a challenging practice for both anesthesiologist and bronchoscopist because loss of airway control and sever hypoxemia can occur following induction of anesthesia. Inhalational induction with avoiding muscle relaxants and preservation of spontaneous breathing is commonly recommended in these patients. However, this technique needs a long time to reach the appropriate levels of anesthesia and may be associated with the risk of complete airway obstruction during airway manipulation. This paper describes our experience in using rapid intravenous induction of anesthesia for dilation of severe tracheal stenosis with rigid bronchoscopy. Materials and Methods : We conducted a retrospective chart review of one hundred patients with benign severe post intubation tracheal stenosis who underwent rigid bronchoscopy for dilation of stenosis using intravenous sodium thiopental and succinylcholine for induction of general anesthesia. Results : In 97 patients adequate airway was established immediately after induction of anesthesia with the first attempt of rigid bronchoscope. In one patient, because of local bleeding and mild hypoxemia the airway was managed by a 4 mm tracheal tube and following improvement of oxygenation, dilatation of stricture was successfully done with rigid bronchoscope. In second patient, after passing the first bronchoscope, due to risk of rupturing the trachea, a small transverse cervical incision was made on the trachea and a tracheal tube was inserted through it for patient’s ventilation and dilatation of stricture was managed safely with the rigid bronchoscopes. In the third patient, due to failure of passing the bronchoscope, the trachea was intubated with a 4 mm endotracheal tube and tracheal resection and anastomosis was done successfully. Conclusion : in patients with severe post intubation tracheal stenosis, rapid intravenous induction of anesthesia is a safe method for passage of rigid bronchoscope for dilatation of stricture. Careful planning and close cooperation of the anesthesia and surgical teams is critical for safe and successful conduction of this procedure.