title: Emergency cricothyroidotomy following tracheobronchial stenting.
abstract: A man aged 51 years was referred for tracheobronchial stenting after a poorly differentiated oesophageal carcinoma had progressed to cause stridor. Bronchoscopy revealed a left vocal cord palsy and tumour infiltration into the trachea. A tracheobronchial stent was placed, and after distal migration was endoscopically resited. Returning from theatre, the patient developed severe upper airway obstruction that progressed to cause CO2narcosis and loss of consciousness. A rapid sequence induction was initiated, and a Glidescope revealed bilateral vocal cord palsy with severe oedema causing an inability to pass a tube or stylet. Tracheostomy was attempted above the suprasternal notch but was obstructed by the stent. Oxygen saturations dropped steadily, reaching as low as 38%. Emergency cricothyroidotomy was performed, compliant with DAS guidelines, that proved successful. The stent was removed, which was blocked with blood and secretions, and tracheostomy was placed 2 days later. The patient made a full neurological recovery.
authors.affiliation: Department of Cardiothoracic Intensive Care, Saint George's Healthcare NHS Trust, London, UK.
authors.forename: Simon Robert
authors.initials: SR
authors.lastname: Cavinato
authors.affiliation: Saint George's Healthcare NHS Trust, London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Denning
authors.affiliation: Department of Cardiothoracic, ST Georges Hospital NHS Trust, London, UK.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: Madden
mesh_terms: D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery*; D001980:Bronchi; D004630:Emergencies; D004938:Esophageal Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012135:Respiratory Sounds / Q000209:etiology; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D014132:Trachea