Mieda Hideyuki, Nagano Yuri, Iwasaki Etsu, Oishi Yuri, Sasai Takako, Shin Yoshiaki, Watanabe Yoko, Oku Satoru, Fukushima Tomihiro, Tokioka Hiroaki
Department of Anesthesiology, Okayama Red Cross General Hospital, Okayama 700-8607.
Masui. 2012 Aug;61(8):880-4.
Anesthesia for the tracheobronchial stent placement involves the risk of airway narrowing and obstruction. Controlled ventilation with relatively high airway pressure is usually used to maintain oxygenation and ventilation during anesthesia. However, controlled ventilation does not always provide tidal volume and oxygenation due to gas leakage from tracheobronchial fistula. We report 2 cases of general anesthesia under spontaneous respiration for the airway stent placement to treat tracheal and bronchial fistula. Case 1; A 55-year-old man with tracheoesophageal fistula due to the esophageal cancer was scheduled for the stent placement. Anesthesia was given with dexmedetomidine and sevoflurane preserving spontaneous respiration. The surgery was performed without complications of hypoventilation and hypoxemia throughout the procedure. Case 2; A 71-year-old woman developed empyema with large bronchopleural fistula as the result of the complication of radiation for the breast cancer. The stent placement was scheduled for closure of the fistula. Anesthesia was induced with remifentanil and sevoflurane with spontaneous respiration. When inserting the rigid bronchoscope, cough reflex occurred and propofol was added to deepen the anesthesia. The stent placement was performed with general anesthesia under spontaneous respiration without any complications.
气管支气管支架置入术的麻醉存在气道狭窄和梗阻的风险。在麻醉期间，通常使用相对较高气道压力的控制通气来维持氧合和通气。然而，由于气管支气管瘘漏气，控制通气并不总能保证潮气量和氧合。我们报告2例在自主呼吸下进行全身麻醉以置入气道支架治疗气管和支气管瘘的病例。病例1：一名55岁因食管癌导致气管食管瘘的男性计划进行支架置入术。使用右美托咪定和七氟醚进行麻醉，保留自主呼吸。整个手术过程中未出现通气不足和低氧血症并发症。病例2：一名71岁女性因乳腺癌放疗并发症出现脓胸并伴有大的支气管胸膜瘘。计划进行支架置入术以封闭瘘口。使用瑞芬太尼和七氟醚诱导麻醉并保留自主呼吸。插入硬支气管镜时出现咳嗽反射，遂加用丙泊酚加深麻醉。在自主呼吸下进行全身麻醉完成支架置入术，未出现任何并发症。
