Anesthesia for insertion of a Dumon stent in a patient with a large tracheo-esophageal fistula.

PURPOSE

To present the anesthetic management for the insertion of a Dumon silicon stent to the trachea of a patient with a large tracheo-esophageal fistula. The aim of the stent insertion was to seal the fistula in order to prevent aspiration of esophageal content and subsequent pneumonitis.

CLINICAL FEATURES

A 45-yr-old man with a large tracheo-esophageal fistula was scheduled for the insertion of the Dumon stent. Since placement of the stent necessitates the insertion of a rigid bronchoscope, under general anesthesia, with its tip just proximal to the fistula, controlled ventilation was expected to be difficult to achieve because of the diversion of oxygen through the large fistula to the esophagus. We successfully ventilated the lungs, after the fistula was sealed using a large balloon which was inserted in the esophagus, and the stent insertion was completed uneventfully.

CONCLUSION

Anesthesia for procedures involving the central airway is challenging. This report describes a simple and practical method to facilitate ventilation by temporary seal of a tracheo-esophageal fistula using a modified esophageal balloon.