Journal of Anaesthesia & Critical Care Case Reports

Vol 9 | Issue 1 | January-April 2023 | Page: 04-08 | Chetan Mehra, Charu Shrotriya, Chitra Chatterji

DOI: https://doi.org/10.13107/jaccr.2023.v09i01.211

Author: Chetan Mehra [1], Charu Shrotriya [1], Chitra Chatterji [1]

[1] 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.
E-mail: Chetanmehra@yahoo.co.in

Abstract

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

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