Airway Stenosis Research Articles

Glottic and Subglottic Injury and Development of Pediatric Airway Stenosis.

To determine how often children with airway injury at the time of tracheostomy develop airway stenosis. A 7-year retrospective review of a prospectively maintained database of pediatric patients who underwent endotracheal intubation followed by tracheostomy with concurrent and follow-up direct laryngoscopy. Tertiary care hospital. Outcomes included glottic or subglottic injury and progression to stenosis. Univariate and multivariate analyses were performed via SPSS. Of the 222 patients (median age at surgery, 0.6 years; 54% male) who met study criteria, 46% had airway injury at the time of tracheostomy. Patients with congenital cardiovascular disease had 2.33-times increased risk of developing airway injury (P = .01). Patients with airway injury on initial direct laryngoscopy developed stenosis significantly more frequently than those without injury (30% vs 12%, P < .01). Risks factors for developing stenosis in children with airway injury include prematurity (P = .02), younger age at time of surgery (P < .01), endotracheal tube size (P < .01), Down syndrome (P = .03), and neonatal (P = .02) and/or congenital cardiovascular (P < .01) diagnosis. However, none of these variables were significant on multivariate analysis. Intubated patients with evidence of glottic or subglottic injury at the time of tracheotomy are more likely to develop airway stenosis than those without. Congenital heart disease was associated with twice the risk of developing airway injury, while progression to stenosis was associated with younger age, prematurity, and/or comorbid diagnoses.

Deep Learning for Automatic Upper Airway Obstruction Detection by Analysis of Flow-Volume Curve

Background: Due to the similar symptoms of upper airway obstruction to asthma, misdiagnosis is common. Spirometry is a cost-effective screening test for upper airway obstruction and its characteristic patterns involving fixed, variable intrathoracic and extrathoracic lesions. We aimed to develop a deep learning model to detect upper airway obstruction patterns and compared its performance with that of lung function clinicians. Methods: Spirometry records were reviewed to detect the possible condition of airway stenosis. Then they were confirmed by the gold standard (e.g., computed tomography, endoscopy, or clinic diagnosis of upper airway obstruction). Images and indices derived from flow-volume curves were used for training and testing the model. Clinicians determined cases using spirometry records from the test set. The deep learning model evaluated the same data. Results: Of 45,831 patients’ spirometry records, 564 subjects with curves suggesting upper airway obstruction, after verified by the gold standard, 351 patients were confirmed. These cases and another 200 cases without airway stenosis were used as the training and testing sets. 432 clinicians evaluated 20 cases of each of the three patterns and 20 no airway stenosis cases (n = 80). They assigned an accuracy of 41.2% (±15.4) (interquartile range: 27.5–52.5%), with poor agreements (κ = 0.12). For the same cases, the model generated a correct detection of 81.3% (p < 0.0001). Conclusions: Deep learning could detect upper airway obstruction patterns from other classic patterns of ventilatory defects with high accuracy, whereas clinicians presented marked errors and variabilities. The model may serve as a support tool to enhance clinicians’ correct diagnosis of upper airway obstruction using spirometry.

Personalized 3D-Printed Bioresorbable Airway External Splint for Tracheomalacia Combined With Congenital Heart Disease.

Severe tracheomalacia (TM) patients with respiratory symptoms need surgical intervention, including aortopexy, internal stents or external splint. While some patients continue to have respiratory symptoms after tracheal relief, and there is no evidence to support any one surgery therapy over another. Here we introduce a clinical safety and efficacy of the three-dimensional (3D)-printed bioresorbable airway external splints in treating congenital heart disease (CHD) patients with severe TM. From May 2019 to September 2020, nine patients with severe TM were enrolled. The median age was 5 months (range, 3–25 months), and the median weight was 7.5 kg (range, 3–15 kg). All patients had wheezing, and two patients were assisted by machine ventilation (MV) preoperatively. The median length of TM was 1.5 cm (range, 1.0–3.0 cm). All patients underwent suspension of a “C”-shaped lumen airway external splint, which were designed in SOLIDWORKS and made of polycaprolactone (PCL). The airway external splint could provided effective support for at least 6 months and was completely degraded into carbon dioxide and water within 2–3 years. The median time of postoperative machine assisted ventilation was 23.7 h (range, 3.3–223.4 h), and the median time of ICU stay was 9 days (range, 4–25 days). The median follow-up time was 18 months (range, 12–24 months). Respiratory symptoms were all relieved, and no external splint-associated complications occurred. The 3D computed tomography reconstruction showed no airway stenosis. Personalized 3D-printed bioresorbable airway external splint can not only limit external compression and prevent airway collapse but also ensure the growth potential of the airway, which is a safe, reliable and effective treatment for CHD with TM.

Innovative artificial lesions to mimic difficult airway pathology in cadavers, supporting airway management training

BackgroundClinicians working in anesthesiology or critical care medicine often face difficult airway situations. Moreover, time is limited to make the right decisions while securing the airway for critically ill patients. Although the modern airway management approach is strategy-based, it remains essential to provide an adequate level of training to acquire technical skills. Cadaver-based skill training is considered to be one of the highest levels of education. AimUsing an innovative method we aimed to create realistic artificial lesions making airway management difficult on specially soft-fixed human preparations. MethodsWe produced submucosal upper and lower airway lesions by injecting green-coloured liquid silicone. First, 10 non-fixed human head and neck visceral complexes were injected by suprahyoidal, infrahyoidal or transcricothyroidal lateral punctures. After the silicone crosslinked, the preparations were fixed (4% formaldehyde) and the lesions were visualized by sections. Then in situ lesions were implanted by percutaneous puncture of 5 Thiel-fixed head preparations. Tracheal stenosis was achieved by external ligature. Videolaryngoscopic images were taken under comparable parameters before and after implantation. ResultsThe lesions created proved to be realistic in their localisation and shape. The tissues were optimally infiltrated and not fragile. In the in situ models significant airway stenoses and anatomical deformities were induced. ConclusionAs first step of a long-term project the current paper has only attempted to communicate modelling as a technical report on creating standardized artificial airway difficulties for education or research. Our models provide an opportunity to increase the anatomical diversity and realism of airway management courses. A systematically designed educational unit consisting of several cadavers is an invaluable tool in training, the role of which is planned to be analyzed.

Clinical experience of transbronchoscopic laser ablation for central airway stenosis using a high-power diode laser-ten years' experience at a single institute.

High-power diode (GaAlAs) laser systems have been used for transbronchoscopic laser ablation for central airway stenosis. Such diode laser systems show a similar clinical effect to a conventional Nd-YAG laser, but the instrument is more compact with easier handling. We use a high-power diode laser system with a non-contact probe for endobronchial ablative therapy. The present study reviewed our experience with transbronchoscopic laser ablation to explore a better clinical approach for managing central airway lesions. We retrospectively reviewed the patients who were treated for central airway lesions by transbronchial laser ablation using the non-contact-type probe from January 2005 to December 2015 at Chiba University Hospital. We investigated the cause of stenosis, number of treatments, laser setting, total amount of energy, complications, and simultaneously performed modality. Thirty-three patients underwent treatment a total of 72 times. There were 23 males, with an average age of 60.3 years old (range, 18-80 years old). The primary causes of the central airway stenosis were neoplastic disease in 22 (16 malignant tumors, 6 benign tumors) and non-neoplastic disease in 11. Among malignant tumors, there were eight tracheal cancer and five lung cancer patients as well as three patients with esophageal cancer. Among benign tumors, there were three hamartomas and one patient each with papilloma, smooth muscle tumor, and glomus tumor. The non-neoplastic causes of airway stenosis were intubation or tracheotomy in four patients, tuberculosis and granulation in two each, and trauma, burn, and surgery in one each. The numbers of treatments were 30 times (1.36 times/patient) for neoplastic diseases and 42 times (3.82 times/patient) for non-neoplastic disease. The total amount of energy was 1,936 J on average (1,674 J for neoplastic diseases and 2,098 J for non-neoplastic disease). There were no major complications related to transbronchial laser ablation therapy. Transbronchoscopic laser ablation using a diode laser system with a non-contact probe can be safely performed and is useful for endobronchial treatment of both neoplastic and non-neoplastic central airway lesions.

A narrative review of progress in airway stents.

Background and ObjectiveAirway stents, used to restore airway patency, are mostly utilized by patients with malignant airway strictures, and are occasionally used in a range of other airway related diseases, including conditions which result in benign stenosis, malacia, and fistula. There has been an increasing number of airway stents that are being developed thanks to improvements in interventional therapy. However, the method of promoting airway stents for clinical application remains undetermined. Herein, we describe the recent advances in airway stents by reviewing the published studies, providing the reference for clinical decision-making and further research on airway stents.MethodsRelevant articles between January 1964 and November 2021 were obtained from PubMed, Web of Science, and EMBASE databases. The terms “metallic”, “silicone”, “drug-eluting", “biodegradable”, “radioactive”, “three-dimensional (3D)”, and “stents” were searched in different combinations.Key Content and FindingsIn this review, we focus on the latest evidence in terms of the application of various stents with novel materials and designs including novel metallic, novel silicone, drug-eluting, biodegradable, radioactive, and 3D stents for airway stenosis. Despite reducing the well-known complications of all current commercially available stents, novel stents are still in their infancy without a long track record of utility and safety, and remain some limitations. There are more steps to be taken before such stents enter routine clinical practice.ConclusionsA combination of 3D-printing method and biodegradable material may present a promising avenue of solving the existing problems pertaining to “classic” stents and has potential to become the main trend in the future.

Sequential treatment of severe airway stenosis caused by esophageal cancer by using airway stent implantation and arterial infusion chemotherapy

The purpose of this clinical study was to investigate the efficacy and safety of airway stent implantation and transarterial infusion chemotherapy in the sequential treatment of severe airway stenosis caused by esophageal cancer. Data of patients with advanced esophageal cancer complicated by severe airway stenosis treated with airway stent implantation and transarterial infusion chemotherapy were retrospectively analyzed. Furthermore, dyspnea, clinical efficacy, adverse reactions, and survival of patients were evaluated. 71 patients were included in this study. There were 28 patients with grade III dyspnea and 43 patients with grade IV dyspnea before airway stent implantation, and 34 patients with grade I dyspnea, 35 patients with grade II dyspnea and 2 patients with grade III dyspnea after airway stent implantation. After airway stent implantation and 1–3 courses of transarterial infusion chemotherapy, 11, 41 and 19 patients had complete response, partial response and stable response respectively. Total disease control rate (DCR) and objective response rate (ORR) were 100.0% and 73.2%, respectively. During the follow-up, 32 patients died of organ failure, 24 patients died of tumor-related respiratory failure, and 10 patients died of gastrointestinal bleeding. The median survival time of all patients was 8 months, and the 1-year survival rate was 40.8%. Airway stent implantation combined with arterial infusion chemotherapy is safe and effective for sequential treatment of esophageal cancer with severe airway stenosis.

Effect of Bronchoscopic Interventions on Long-Term Lung Function Among Lung Transplant Recipients due to Cystic Fibrosis: A Single-Center Study

Patients with end-stage lung disease owing to cystic fibrosis may require lung transplant, provided other therapeutic options were exhausted. During the posttransplant period, bronchial anastomoses' healing may sometimes be complicated and require bronchoscopic intervention (BI). The main aim of this study was to assess BI and its effect on long-term lung function among cystic fibrosis lung transplant recipients who have reached 2-year survival. This retrospective study includes 22 patients with cystic fibrosis who underwent primary double lung transplant in a single center between 2018 and 2020 and have checked in for their 2-year follow-up visit. BI is defined as performing endoscopic bronchoplasty through balloon dilatation, cryoprobe, argon plasma, and/or laser treatment. All patients, who did not require BI during the first year, did not need bronchoplasty during the second posttransplant year as well. Results of forced expiratory volume in 1 second as percentage of predicted value and the 6-minute walk distance were similar at 2-year follow-up to those obtained at the end of 1 year for all patients. Significant time effects were observed for forced vital capacity (FVC) (weak effect), FVC as percentage of predicted value (weak effect), and forced expiratory volume in 1 second/FVC (moderate effect). Patients who had never had bronchoscopic intervention owing to airway stenosis, as well as those who did in the first posttransplant year, maintained forced expiratory volume in 1 second as percentage of predicted value at a comparable level at the second posttransplant year follow-up visit. The number of BIs significantly decreased among patients, who were undergoing such procedures during the first posttransplant year.

Orthognathic surgery and obstructive sleep apnea syndrome: a systematic review

Introduction: In the scenario of Obstructive Sleep Apnea Syndrome (OSAS), Orthognathic Surgery (OS) corrected the deformities of the maxillary and mandibular bones OS has evolved a lot in the last two decades. OS treats patients with moderate and severe facial deformities, allowing the achievement of functional balance and harmony in facial aesthetics. Objective: To present the current findings of the importance of orthognathic surgery in the treatment of obstructive sleep apnea syndrome. Methods: A total of 78 articles were found involving mesh terms about Orthognathic Surgery and OSAS. Initially, was held the exclusion of existing title and duplications following the interest described in this work. After this process, the summaries were evaluated, and a new exclusion was held. Thus, 20 articles were included and discussed in this study. Major considerations and conclusion: In recent years, with the involvement and deepening of oral medicine in the diagnosis and treatment of OSAS, the role of OS in OSAS has become increasingly recognized. Early appropriate diagnosis and treatment can significantly improve patients' quality of life, reduce sudden death, and prevent various complications. OS corrects maxillofacial deformities through an incision of the upper and lower jaws, which has a significant relief effect on the symptoms of OSAS in patients with upper airway stenosis, especially in small mandibular patients.

Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience.

SUMMARYObjectiveThe COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation.MethodsA case series of patients who underwent tracheal resection and anastomosis (TRA) for post-COVID-19 LTS was collected from June 2020 to September 2021.ResultsAmong 14 patients included, 50% had diabetes and 64.3% were obese. During intensive care unit stay, mean duration of orotracheal intubation (OTI) was 15.2 days and 10 patients (71.4%) underwent tracheostomy, which was maintained in 7 for an average of 31 days. According to the European Laryngological Society classification, 13 patients (92.9%) had a grade IIIa LTS and one a grade IIIa+. All patients underwent Type A TRA, according to the authors’ classification. No major perioperative complications were reported and at the last follow-up all patients were asymptomatic.ConclusionsWith the appropriate indications, TRA represents an effective treatment in post-COVID-19 LTS patients. Short OTI times and careful tracheostomy are required in order to reduce the incidence of airway injury.

Cervical Repair of Iatrogenic Tracheobronchial Injury by Tracheal T-Incision

BackgroundTracheobronchial injury is a rare but potentially life-threatening condition. Various surgical treatment options have been described for symptomatic patients with full-thickness injury. However, studies comprising a meaningful number of patients are sparse. MethodsWe retrospectively analyzed all patients who received surgical repair of tracheobronchial injury between January 1999 and May 2021 at the Department of Thoracic Surgery, Medical University of Vienna. Patient characteristics, surgical variables, postoperative morbidity, and mortality were retrieved and analyzed. ResultsFifty patients with a median age of 68 years (range, 17-88) were included in the analysis. The etiologies of the iatrogenic tracheobronchial injuries were emergency intubation (48%), elective percutaneous dilatation tracheostomy (38%), or elective intubation (14%). The most common location of tracheobronchial injuries was distal third (28%) with a median length of 50 mm (range, 20-100 mm). The surgical approach was cervicotomy in 52%, thoracotomy in 38%, sternotomy in 2%, and combined approaches in 8% of cases. Moreover, intraoperative venovenous (n = 4) or venoarterial (n = 2) extracorporeal membrane oxygenation support was required in 12% of cases. Procedure-related mortality was 0%. However, as patients with tracheobronchial injury usually have severe comorbidities, the rate of patients discharged alive from the intensive care unit was only 66%. The median follow-up period of discharged patients was 5.5 months (range, 0.7-209). Airway stenosis or dehiscence was not observed in any patient. ConclusionsSurgical repair of tracheobronchial injuries can be performed safely with a low procedure-related morbidity. If possible, the less-invasive cervical access should be preferred for patients with tracheobronchial injury, even for injuries extending to the main bronchi.

Laryngeal web with 22q11.2 deletion syndrome.

Laryngeal web is a rare congenital or acquired disease that results in airway stenosis. Depending on the severity of atresia, patients with laryngeal web show a wide variety of symptoms ranging from asymptomatic to life-threatening respiratory dysfunction that may require emergency tracheostomy immediately after birth. We report a neonatal case of laryngeal web with 22q11.2 deletion syndrome. Post-delivery, the infant showed dysphonia and had a ventricular septal defect with characteristic craniofacial features. The infant underwent an endoscopic incision of the web and cardiac surgery. Among patients with laryngeal web, 30% have 22q11.2 deletion syndrome. 22q11.2 deletion syndrome is the most common chromosomal microdeletion syndrome and the second most common chromosomal abnormality associated with congenital heart disease. Therefore, if an infant has laryngeal web with comorbidities such as congenital heart disease, 22q11.2 deletion syndrome should be considered in differential diagnosis.

Modified Minerva Orthosis for Postoperative Management of Cricotracheal Resection in Children

ABSTRACT Introduction Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the neck is kept in a neutral or slightly flexed position. We describe a novel design and fitting of a modified pediatric Lerman Minerva cervical-thoracic orthosis (CTO) in our pediatric patient population after CTR or TR to protect the anastomosis. Method A Minerva CTO is customized to reduce anastomotic tension. The mandibular extension is removed, occipital extension is recontoured, plastic is trimmed, and a perineal strap is added. The orthosis allows avoidance/removal of the manubrial-mandibular suture, reducing skin complications and increasing mobilization. Discussion This modified Minerva CTO provided three key benefits: it can be sized down to fit small children, provides the desired immobilization, and is adjustable during fitting to ensure that the angle of cervical flexion is appropriate to protect the anastomosis. Conclusion After CTR and TR, proper cervical positioning is crucial to avoid tension on the anastomosis. Our novel modification of the Minerva orthosis is a useful adjunct in the postoperative management of these patients. Clinical relevance This modified pediatric Lerman Minerva CTO is a useful adjunct to protect the anastomosis following CTR or TR.

Central airway obstruction treatment with self-expanding covered Y-carina nitinol stents: A single center retrospective analysis.

BackgroundCentral airway obstruction (CAO) is one of the most challenging, potentially lethal complications in malignant and benign respiratory diseases. Worsening dyspnea is also a relevant cause for reduced quality of life in such patients. Here, we present our data on the application of covered, self‐expanding Y‐carina nitinol stents due to benign and malignant diseases.MethodsWe retrospectively identified 27 patients who had undergone 31 rigid bronchoscopies with implantation of covered Y‐carina nitinol stents over a period of 10 years in order to evaluate indication, clinical course, and outcome.ResultsShort‐term survival of successfully stented patients with palliative and curative treatment goal did not differ, allowing for diagnosis independent indication. With respect to overall survival, patients with endoluminal obstruction benefited most compared to patients with fistula and/or external compression. Granulation tissue formation (61.3%) and mucus plugging (80.6%) were the most frequent complications. Material defect (6.5%) and migration (3.2%) were rare complications that could be handled by revisional rigid bronchoscopy and stent exchange in some cases.ConclusionsImplantation of self‐expanding covered Y‐carina nitinol stents via rigid bronchoscopy is a feasible and safe treatment option for benign and malignant central airway obstruction. Especially in palliative, malignant airway stenosis, stenting might facilitate additional treatment options and optimize dyspnea and eventually quality of life.

Role of pyroptosis pathway related molecules in acute lung injury induced by gas explosion in rats

Objective: To explore the role and significance of pyroptosis in gas explosion-induced acute lung injury (ALI) in rats. Methods: In February 2018, 126 SPF male SD rats were selected and randomly divided into blank control group (18 rats) and experimental group (40 m, 80 m, 120 m, 160 m, 200 m and 240 m, 18 per group) . The experimental group carried out gas explosion in the roadway to build the ALI model, the control group did not carry out gas explosion, and other conditions were consistent with the experimental group. Respiratory function indexes such as respiratory frequency (f) , tidal volume (TV) , minute ventilation (MV) and airway stenosis index (Penh) were measured 24 hours after the explosion. 5 rats in each group were sacrificed after anesthesia, Hematoxylin-Eosin (HE) staining was used to observe the pathological morphology of lung tissue. Immunohistochemistry was used to detect the content of Caspase-1. Western blotting was used to detect the content of cell pyroptosis including nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) , Caspase-1, interleukin-1β (IL-1β) and interleukin-18 (IL-18) in lung tissue related protein expression. Results: The f and MV of rats in the experimental group were higher than those in the control group (P<0.05) . Except for the 40 m and 80 m groups, the TV of rats in the other experimental groups were higher than those in the control group (P<0.05) . Except for the 40 m group, the Penh of rats in the experimental groups were lower than those in the control group (P<0.05) . HE staining showed that the lung tissue of the experimental groups at different distance points showed obvious edema of the pulmonary interstitium and alveoli, a large number of red blood cells and inflammatory cells exuded in the alveolar space, thickening of the pulmonary interstitium, and increased lung injury score (P<0.05) . The results of immunohistochemistry showed that the positive expression of Caspase-1 in each experimental group was higher than that in the control group (P<0.05) . Western blotting results showed that the expression of pyroptosis-related proteins in each experimental group was higher than that in the control group (P<0.05) . Conclusion: Pyroptosis is involved in the pathophysiological process of gas explosion-induced ALI in rats.

A Case of Neurofibromatosis Type 1 Whose Life Was Saved after Rapid Cervical Swelling and Airway Stenosis Caused by Multiple Arterial Ruptures

A Case of Neurofibromatosis Type 1 Whose Life Was Saved after Rapid Cervical Swelling and Airway Stenosis Caused by Multiple Arterial Ruptures

Tracheal Reconstruction with the Scaffolded Cartilage Sheets in an Orthotopic Animal Model.

Tracheal reconstruction remains challenged in clinical. We aimed to fabricate scaffolded cartilage sheets with rigid and elastic supports for tracheal reconstruction. The chondrocyte cell infiltration activity was examined in poly-caprolactone sheet scaffolds with various thicknesses and pore sizes after seeding cells on the top surface of the sheet scaffolds. The expression of cartilage-related genes and accumulation of sulfated glycosaminoglycans were elevated in the cell-scaffold composites upon chondrogenic induction. The thicker cartilage sheets represented stronger mechanical properties than the thinner cartilage sheets. Two different cartilage sheets were orthotopically implanted into a trachea in a rabbit model for 2, 4, and 16 weeks. Cartilage-related sulfated glycosaminoglycans and type II collagen macromolecules were stably expressed in the tracheal implants. However, the invasive migration of fibrous tissue and profibrotic collagen fibers into cartilage implants and the peripheral space surrounding the implants were elevated in a time-dependent manner. At week 16 postimplantation, airway stenosis was noticed under the thicker sheet implants, but not the thinner implants, suggesting that the thinner (1 mm thick) scaffolded cartilage sheet was an optimal candidate for tracheal reconstruction in this study. Finally, cartilage sheets could be a reconstructive therapy candidate applied to reconstruct defects in the trachea and other tissues composed of cartilage. Impact statement Tissue engineering is a promising approach to generate biological substitutes. We aimed to develop cartilage sheets as tracheal prosthesis used in tracheal reconstruction or regional repairing in the animal model. The formation of microvessels and the dynamics of reepithelialization were monitored for 16 weeks in tracheal implants of the engineered cartilage sheets. In this study, it was demonstrated that the tissue-engineered cartilage sheets are potential substitutes applied in the reconstruction of the trachea and other tissues composed of cartilage tissue. The cartilage sheets were thought of as biomaterials for personalized regenerative medicine since the dimensions, thickness, and pore sizes of cartilage sheets were tunable to fit the lesions that need to be reconstructed.

Anesthesia management in geriatric patients which were interventional bronchoscopy due to central airway obstruction; retrospective analysis

Aim: In the endobronchial treatment of tumors that cause obstruction in the tracheobronchial system; Applications such as cryo-recanalization and argon plasma coagulation (APC) are widely used. Patients presenting with central airway obstruction (CAO) require urgent intervention, sharing the airway with the bronchoscopist, severe shortness of breath in patients, and the presence of comorbid diseases make it difficult for anesthetists. This situation becomes more complicated due to pharmacokinetic and pharmacodynamic changes in geriatric patients. In this article, it is aimed to present the anesthesia method in geriatric patients who underwent interventional bronchoscopy due to central airway obstruction.&#x0D; Material and Method: The files of geriatric patients who underwent interventional procedures for central airway obstruction between January 2021 and September 2021 were reviewed retrospectively. The treatments applied to the patients and the applied anesthetic protocols were recorded.&#x0D; Results: Forty-five geriatric patients who underwent interventional procedures for CAO were identified. 74% of the patients were male. 95.6% of the patients were in the American Society of Anesthesiologists (ASA) III or ASA IV risk group, which we can refer to as the high risk group. It was observed that rapid and short-acting propofol and remifentanil were used in induction and maintenance of anesthesia, rocuronium was used as muscle relaxant, and sugammadex was used to eliminate the residual effect of the muscle relaxant.&#x0D; Conclusion: Airway management is very complex in severe life-threatening airway stenosis. This situation requires a more comprehensive preoperative evaluation, selection of appropriate short-acting anesthetics, and effective anesthetic monitoring, especially in geriatric patients. In addition, the anesthetist and bronchoscopist should be prepared and in constant communication against complications that may develop.

Paclitaxel-Loaded PLGA Coating Stents in the Treatment of Benign Cicatrical Airway Stenosis

Background: Airway stent implantation used in the treatment of benign cicatricial airway stenosis (BCAS) can lead to local granulation and scar formation, resulting in restenosis and treatment failure. Methods: We systematically investigated a paclitaxel-loaded PLGA-coating stent (PLPCS) and analyzed the safety and efficacy of the PLPCS in patients with BCAS. Patients were enrolled from four hospitals in China and observed for six months after implantation, by bronchoscopy performed weekly in the first month and monthly thereafter. The stent was removed immediately upon detection of granulation tissue proliferation, leading to immobility of the stent. Results: Granulation tissue was formed one week after stent implantation, most of which was located at the upper edge of the stent and the narrowest airway in the stent. All stents were removed in three months (mean: 6.51 + 4.67 weeks), with a curative outcome in one case and ineffective results in two. The remaining seven patients developed complications within three months, necessitating early stent removal. The main complication was granulation formation, resulting in difficulty in stent removal. Conclusion: Although PLPCS showed beneficial effects in basic and animal experiments, it cannot prevent airway restenosis in actual practice, mainly due to granulation formation.

Midterm results of arch augmentation with autologous vascular patch in interrupted aortic arch.

Aortic arch reconstruction of interrupted aortic arch remains challenging, and subsequent problems, including arch and airway stenosis, may occur. Thus, we investigated midterm results of an augmentation technique using autologous vascular patch. This retrospective study included 24 patients who underwent arch reconstruction with an autologous vascular patch for interrupted aortic arch with biventricular physiology from 2006 to 2018. The median age and body weight at operation were 10 days (range 4-77 days) and 3 kg (range 2.5-5.1 kg), respectively. The reconstructed arch was supplemented in the lesser curvature with an autologous vascular patch that was harvested from main pulmonary artery (n = 19), left subclavian artery (n = 3) or aberrant right subclavian artery (n = 1). One patient used patches from both the main pulmonary and left subclavian artery. There was 1 early death due to right heart failure. All survivors were discharged 15 days (range 9-58 days) after surgery without residual arch stenosis. Late death occurred in 1 patient with Cri-du-chat syndrome and airway stenosis. Two reoperations and 1 intervention for arch stenosis were performed. The 1-, 5- and 10-year survival was 92%. Freedom from reoperation or intervention for arch stenosis was 86% 1, 5 and 10 years after surgery. No occurrence of arch aneurysm formation, left main bronchial stenosis and significant hypertension was found during a median follow-up period of 5.5 years (range 0.3-13.3 years). Augmenting the lesser curvature with an autologous vascular patch during arch reconstruction resulted in reasonable midterm outcomes.