[Anesthetic management of Y-shaped tracheobronchial stent insertion via tracheostomy site]

We report two cases of Y-shaped tracheobronchial stent insertion via tracheostomy site. A 62-year-old woman diagnosed with tracheo-gastric roll fistula after subtotal esophagectomy and a 47-year-old woman diagnosed tracheobronchial stenosis due to lung cancer underwent Y-shaped tracheobronchial stent insertion. In both cases, anesthesia was induced and maintained by propofol, remifentanil, and rocuronium. After general anesthesia was induced, oral tracheal tube was inserted and Y-shaped tracheobronchial stent was inserted via tracheostomy site. Patients were apneic during surgical procedure and ventilated via oral tracheal tube in case of Sp(O2) decrease. During ventilation, the operator closed tracheostomy by hand. We used oral tracheal tube with short cuff which enabled surgical procedure without extubation. Compared with metal stent, silicone Y-shaped tracheobronchial stent needs much more time for insertion. Therefore, oral insertion needs frequent intubation and extubation which causes airway mucosal edema or damage. Our method, stent insertion via tracheostomy site and ventilation via oral tracheal tube, was compatible with safer airway management and surgical procedure.