Anesthetic Management in Tracheal Dilatation for Severe Tracheal Stenosis

We report the anesthetic management of a 65-year-old woman with recurrent, severe tracheal stenosis who underwent tracheal dilatation. She had visited the Department of Respiratory Medicine at our hospital for respiratory distress approximately 20 years ago, and had undergone laser ablation under local anesthesia. Because of recurrence and aggravation of respiratory distress, she now presented at the Department of Thoracic Surgery, and was scheduled for surgery. Percutaneous cardiopulmonary support was prepared, and she was sedated with midazolam and dexmedetomidine. Under bronchoscopic guidance, a 5-mm intubation tube was placed directly above the stenosis site. Laser ablation (by argon plasma coagulation) and balloon dilatation were performed, and the tube was replaced with one with a larger diameter, which was subsequently replaced with another with an even larger diameter. Ultimately, a 7-mm tube was placed beyond the stenosis site, and the operation was completed. After restoration of spontaneous respiration and consciousness, the patient was extubated in the operating room and returned to the intensive care unit. In anesthetic management of patients with tracheal stenosis, treatment of hypoxia is important. In this case, we collaborated with the attending physician, clinical engineers, and operating room nurses throughout, and consequently, were able to perform the operation safely.