Sato Satoshi, Chaki Tomohiro, Onaka Takayuki, Yamakage Michiaki
Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
JA Clin Rep. 2022 Feb 3;8(1):9. doi: 10.1186/s40981-022-00500-z.
Tracheal stenosis is a life-threatening condition, and management of a patient with a risk of tracheal stenosis is challenging for anesthesiologists. In this report, we describe a method for airway management using two gum elastic bougie method when removing a tracheal stent via a tracheostomy orifice with a risk of airway restenosis.
A 71-year-old man had an enlarged squamous cell carcinoma of the lung invading the upper mediastinum that had caused severe stenosis of the trachea. Two months after diagnosis, a tracheal stent had been placed to maintain tracheal patency. One month after stent placement, acute respiratory failure was induced by upper airway obstruction caused by subglottic airway edema due to mechanical stimulation of the cranial end of the stent, and the patient was rescued by oral tracheal intubation. Tracheal stent extraction was scheduled to relieve the laryngeal edema. Since there was a risk of tracheal restenosis because of the possibility of accidental evulsion of the orally tracheal tube which intubated to secure an emergency airway and tracheal stent extraction, two gum elastic bougies were inserted through the oral tracheal tube and tracheostomy orifice to facilitate re-intubation. After extraction of the tracheal stent, airway openness was maintained and tracheostomy was completed without any complication.
Successful management of tracheal stent extraction was performed using a double gum elastic bougie technique.
气管狭窄是一种危及生命的疾病，对于有气管狭窄风险的患者进行管理对麻醉医生来说具有挑战性。在本报告中，我们描述了一种在通过气管造口孔取出有气道再狭窄风险的气管支架时，使用双弹性探条法进行气道管理的方法。
一名71岁男性患有肺鳞状细胞癌，肿瘤增大并侵犯上纵隔，导致气管严重狭窄。诊断后两个月，放置了气管支架以维持气管通畅。支架置入后一个月，由于支架头端的机械刺激导致声门下气道水肿，引起上气道梗阻，诱发急性呼吸衰竭，患者通过经口气管插管获救。计划取出气管支架以缓解喉部水肿。由于为确保紧急气道而插入的经口气管导管可能意外拔出以及气管支架取出后存在气管再狭窄的风险，通过经口气管导管和气管造口孔插入两根弹性探条以利于再次插管。取出气管支架后，气道保持通畅，气管造口术顺利完成，无任何并发症。
使用双弹性探条技术成功完成了气管支架取出的管理。
