Published online Jul 27, 2015. doi: 10.5313/wja.v4.i2.39
Peer-review started: February 2, 2015
First decision: March 6, 2015
Revised: April 24, 2015
Accepted: May 7, 2015
Article in press: May 8, 2015
Published online: July 27, 2015
Processing time: 174 Days and 17 Hours
Airway complications after lung transplantation remain a significant cause of morbidity and mortality. Many of these occur at the anastomotic sites, which are susceptible due to poor collateral circulation. Of the possible complications, bronchial dehiscence is particularly formidable. These cases have been successfully treated bronchoscopically with metallic stents, which likely promote healing through granulation tissue formation. However, limited options exist in cases where the dehiscence fails to heal following stent placement. Here, we present the case report of a 65-year-old male who developed bronchial dehiscence status post bilateral lung transplantation for idiopathic pulmonary fibrosis that failed to heal with simple stent placement. Eventually, the patient underwent amniotic membrane grafting with stenting as a novel therapy for non-healing bronchial dehiscence, for which we describe the anesthetic management. His anesthetic plan included inhalational induction with sevoflurane, propofol infusion for total intravenous anesthesia, rocuronium for muscle relaxation, and closed-circuit assisted ventilation. His existing tracheostomy was used as the airway for oxygenation and induction. In summary, our anesthetic plan for the lung transplant patient was effective; future amniotic membrane grafting for bronchial dehiscence through bronchoscopy may follow a similar technique. Ultimately, the choice of anesthesia in this patient population requires judicious consideration of the requirements of the procedure as well as the pathophysiology of the transplanted lung.
Core tip: Bronchial dehiscence is a significant airway complication following lung transplantation and most commonly occurs at anastomotic sites due to poor collateral perfusion. This complication is often difficult to treat, especially when widespread. Severe disease has been treated with the temporary placement of metallic stents within the airway to promote healing, but limited options exist when stenting fails. This case report presents the anesthetic considerations for a lung transplant patient undergoing bronchoscopic placement of an amniotic membrane graft as a novel solution for non-healing bronchial dehiscence after multiple failed attempts with metallic stent placement.