Case Report
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World J Anesthesiol. Mar 27, 2014; 3(1): 129-133
Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.129
Endoscopic removal of a self-expanding metallic airway stent: A case report
Ying Amy Ye, Michael S Machuzak, D John Doyle
Ying Amy Ye, Michael S Machuzak, D John Doyle, Departments of General Anesthesiology (YAY, DJD) and Pulmonary, Allergy and Critical Care Medicine (MSM), Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Ye YA wrote the first draft of the manuscript and assisted with the anesthetic; Machuzak MS performed the procedure and edited the manuscript; Doyle DJ provided anesthesia for the procedure, edited the original manuscript and revised the manuscript following peer-review.
Correspondence to: D John Doyle, MD, PhD, Departments of General Anesthesiology (YAY, DJD) and Pulmonary, Allergy and Critical Care Medicine (MSM), Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States. doylej@ccf.org
Telephone: +1-216-4441927 Fax: +1-216-4449247.
Received: July 26, 2013
Revised: August 19, 2013
Accepted: August 28, 2013
Published online: March 27, 2014
Processing time: 228 Days and 5.9 Hours
Abstract

Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-year-old man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure (ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external (wearable) cardiac defibrillator (Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion (total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 iGel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.

Keywords: Airway management; Flexible bronchoscope; Rigid bronchoscopy; Self-expanding metallic stents; Supraglottic airway; Total intravenous anesthesia

Core tip: Endoscopic removal of self-expanding metallic airway stents may be necessitated by the formation of extensive granulation tissue, but can pose difficult challenges to both the proceduralist and the anesthesiologist. Total intravenous anesthesia utilizing a propofol infusion and rocuronium for neuromuscular blockade can be useful in such cases. Induction of general anesthesia with etomidate can be useful in patients with poor ventricular function. Airway management can be achieved with an iGel supraglottic airway and later, rigid bronchoscopy.