[Respiratory management during endotracheal placement of the Dumon stent for tracheobronchial stenosis].
BACKGROUND
Endotracheal stenting at the stenotic area of the trachea or bronchus is less invasive and beneficial for patients, compared with conventional surgical treatment.


METHODS
We investigated intraoperative respiratory managements for 26 patients (65+/-14 years-old) with Dumon type stent in a retrospective manner. SpO2 over 90% was an index for the intraoperative respiratory managements.


RESULTS
Nine of the 26 subjects were emergency cases. Four of the 26 patients had been preoperatively under controlled respiration (CR) with an endotracheal tube, while the remaining 22 had been left under spontaneous respiration (SR). The lung cancer (10 patients) was the most frequent causative disease, followed by tracheo-broncheal invasion of the esophageal cancer (6 patients). Preoperative PaO2 in 8 of the SR group was under 70 mmHg. When SR was preserved during subsequent operation, intravenous anesthesia using propofol and fentanyl was given in combination with surface local anesthesia. I-type stent was used for 17 patients with tracheal or bronchial stenosis and Y-type stent for 9 with carina stenosis. As to the respiratory management during stenting, SR was preserved in 14 patients, CR including jet ventilation under the use of a muscle relaxant was performed in 8 patients and percutaneous cardiopulmonary support (PCPS) was used in 4 patients. In one SR patients, SR was switched to emergency PCPS on the way because of airway obstruction. In another SR patient with successful bronchial stenting, the collapsed lung was rapidly re-expanded by using jet ventilation, causing multi-embolism to the vital organs including the heart and the brain. Traumatic complications on bucking were not seen even under the condition of SR. Postoperatively, 21 of the 26 patients were transferred to ICU without endotracheal intubation.


CONCLUSIONS
In a case in which severe respiratory insufficiency or airway bleeding is anticipated, PCPS on standby is necessary for safety assurance.
Kono
Yasuo
Y
Department of Anesthesiology, Kurume University School of Medicine, Kurume 830-0011.
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001982:Bronchial Diseases / Q000628:therapy*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D014135:Tracheal Stenosis / Q000628:therapy*