Paediatric Rigid Bronchoscope and Fogarty Embolectomy Catheter as a Rescue in Successful Management of a Patient with Metallic Tracheal Stent In-Situ: A Case Report
Vol 9 | Issue 1 | January-April 2023 | Page: 04-08 | Chetan Mehra, Charu Shrotriya, Chitra Chatterji
Author: Chetan Mehra , Charu Shrotriya , Chitra Chatterji 
 Department of Anaesthesiology, Critical Care and Pain, Indraprastha Apollo Hospital, New Delhi, India.
Address of Correspondence
Dr. Chetan Mehra,
Consultant Anaesthesiologist, Department of Anaesthesiology, Critical Care and Pain, Indraprastha Apollo Hospital, New Delhi, India.
Our case illustrates the management of a life-threatening difficult airway scenario, in a young male with an in-situ metallic tracheal stent, who was scheduled for excision of the granulation tissue compromising the lumen of stent. He presented with occasional difficulty in breathing, without stridor. An out-patient based nasal video laryngoscopy performed a week prior revealed, granulations at the proximal end of the stent.
Inhalation induction with preservation of spontaneous respiration was performed. Eventually, the patient landed with inability to ventilate and intubate, necessitating a need for emergency establishment of a definitive airway. The presence of metal stent prevented establishment of percutaneous cricothyroidotomy or tracheostomy (FONA- front of neck access).
A paediatric rigid bronchoscope shoved through the granulation tissue, finally established oxygenation. It was used as a conduit for passage of a fogarty catheter, over which a smaller sized endotracheal tube was finally railroaded.
Surgical excision of granulation tissue was performed over endotracheal tube using micro-scissors and patient finally extubated.
This case scenario highlights the importance of a cautious approach towards a potential catastrophe presented by partial obstructed tracheal stent. This requires an effective communication between surgical and anaesthesia teams, as in most cases, an access to airway is limited for anaesthesiologists.
Keywords: Tracheal stent, Rigid bronchoscope, Fogarty catheter
1. Navas-Blanco, Jose R et al. “Emergent airway management in a patient with in situ tracheal stent: A lesson learned.” Saudi journal of anaesthesia vol. 12,4 (2018): 626-628.
2. Sriram, K., Robinson, P. Recurrent airway obstructions in a patient with benign tracheal stenosis and a silicone airway stent: a case report. Cases Journal 1, 226 (2008).
3. Rampey AM, Silvestri GA, Gillespie MB. Combined endoscopic and open approach to the removal of expandable metallic tracheal stents. Arch Otolaryngol Head Neck Surg. 2007;133:37-41.
4. Sanchit A, Barak C, Jochen H, Pierre D, Kurt R. Practical anesthetic considerations in patients undergoing tracheobronchial surgeries: a clinical review of current literature. Journal of Thoracic Disease 2016;8(11):3431-3441.
5. Davis N, Madden BP, Sheth A, Crerar-Gilbert AJ. Airway management of patients with tracheobronchial stents. Br J Anaesth. 2006 Jan;96(1):132-5.
6. Zakaluzny S. Complications of tracheobronchial airway stents. Otolaryngol Head Neck Surg. 2003;128(4):478–88.
7. Morshed K, Trojanowska A, Szymański M, et al. Evaluation of tracheal stenosis: comparison between computed tomography virtual tracheobronchoscopy with multiplanar reformatting, flexible tracheofiberoscopy and intra-operative findings. Eur Arch Otorhinolaryngol 2011;268:591-7.
8. Cheng Q, Zhang J, Wang H, Zhang R, Yue Y, Li L. Effect of acute hypercapnia on outcomes and predictive risk factors for complications among patients receiving bronchoscopic interventions under general anesthesia. PLoS One. 2015;10:e0130771.
9. Burningham AR, Wax MK, Andersen PE, et al. Metallic tracheal stents: complications associated with long-term use in the upper airway. Ann Otol Rhinol Laryngol 2002; 111:285–290.
10. Manfred B, Jennifer M, Claude M, Eva K, Heidrun L, Kurt U. use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data. British Journal of Anaesthesia. Volume 124, Issue1, P63-72, January 01,2020.
11. Daniel DB. The cuff-leak test: what are we measuring? Critical Care. 2005; 9(1):31-33.
12. Benumof and Hagberg’s Airway Management. 2013: 1018-1046.e7.
13. Sato, S., Chaki, T., Onaka, T, et al. anesthetic management of tracheal stent extraction using a double gum elastic bougie technique. JA Clin Rep 8,9 (2022).
14. Bourinet V, Raguin T, Fortin M, et al. experience with transcordal silicone stents in adult laryngotracheal stenosis: a bicentric retrospective study. Respiration. 2018;95:441-8.
15. Daniel N, Tim S, Piotr K. Airway stents: anaesthetic implications, Continuing Education in Anaesthesia Critical Care & Pain, Volume 10, Issue 2, April 2010, Pages 53–58.
16. Iseli TA, Iseli CE, Golden JB, Jones VL, Boudreaux AM, Boyce JR, et al. Outcomes of intubation in difficult airways due to head and neck pathology. Ear Nose Throat J. 2012;91(3):E1-5.
17. Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care. 2014;59(6):865–78; discussion 878-80.
18. Pathak V, Welsby I, Mahmood K, et al. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc 2014;11:628-34.
19. Weinberg L, Graham J, Meyerov J, Moshinsky JA, Aitken SAA, Spanger M, Knight S. Tracheal Stent Buckling and In-stent Stenosis: A Proposed Airway Management Algorithm for Airway Obstruction for Patients With Tracheal Stents. J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):3139-3146.
20. Soeda, R., Taniguchi, F., Sawada, M., Hamaoka, S., Shibasaki, M., Nakajima, Y., Hashimoto, S., Sawa, T., & Nakayama, Y. (2016). Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis. Case reports in anesthesiology, 2016, 6871565.
21. Gao H, Zhu B, Yi J, Ye TH, Huang YG. Urgent tracheal resection and reconstruction assisted by temporary cardiopulmonary bypass: a case report. Chin Med Sci J. 2013 Mar;28(1):55-7.
22. Kim HJ, Asai T. High-flow nasal oxygenation for anesthetic management. Korean J Anesthesiol. 2019;72(6):527-547.
|How to Cite this Article: Mehra C, Shrotriya C, Chatterji C Paediatric Rigid | Bronchoscope and Fogarty Embolectomy Catheter as a Rescue in Successful Management of a Patient with Metallic Tracheal Stent In-Situ: A Case Report | Journal of Anaesthesia and Critical Care Case Reports | January-April 2023; 9(1): 04-08 | https://doi.org/10.13107/jaccr.2023.v09i01.211|
Tags: Fogarty catheter, Rigid bronchoscope, Tracheal stent