title: Anesthesia and airway management for removing pulmonary self-expanding metallic stents.
abstract: The use of bronchoscopically placed self-expanding metallic stents (SEMS) and silastic stents in patients suffering from tracheobronchial stenosis or similar problems has proven to be an important clinical option. When complications occur, it may be necessary to remove the device. Removal of a SEMS is usually performed during general anesthesia with muscle relaxation and positive pressure ventilation, often using total intravenous anesthesia. Airway management depends on stent type and location. Intubating patients' tracheas with a tracheal stent requires special caution, as it risks damaging tissue and dislodging the stent distally. Potential complications with removal include tracheal disruption, retained stent pieces, mucosal tears, re-obstruction requiring new stent placement, the need for postoperative ventilation, pneumothorax, damage to the pulmonary artery, and death.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Department of General Anesthesiology, Case Western Reserve University, Cleveland, OH 44195, USA. doylej@ccf.org
authors.forename: D John
authors.initials: DJ
authors.lastname: Doyle
authors.forename: Basem
authors.initials: B
authors.lastname: Abdelmalak
authors.forename: Michael
authors.initials: M
authors.lastname: Machuzak
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gildea
mesh_terms: D000758:Anesthesia; D001672:Biocompatible Materials; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004129:Dimethylpolysiloxanes; D006801:Humans; D007442:Intubation, Intratracheal; D008168:Lung; D016040:Lung Transplantation; D008670:Metals; D012121:Respiration, Artificial; D015607:Stents; D014135:Tracheal Stenosis / Q000150:complications / Q000601:surgery
chemical_list: D001672:Biocompatible Materials; D004129:Dimethylpolysiloxanes; D008670:Metals; C013830:baysilon