Background: To determine perioperative complications, we evaluate herein 10 cases of anesthetic management for placement of Dumon stent in patient with tracheal or bronchial stenosis due to invasion of esophageal or lung cancer.
Methods: After sufficient oxygenation, anesthesia was induced with propofol and fentanyl. Since muscle relaxant has been considered safe for central-type air way stenosis except for cases involving large anterior mediastinal masses, we administered vecuronium for all cases to facilitate insertion of rigid bronchoscope and for surgical procedures. Anesthesia was maintained with continuous infusion of propofol, and ventilation was performed via a side-port of a rigid bronchoscope with 100% oxygen. Extra corporeal circulation was instituted in 2 cases.
Results: In 5 of the 10 cases, stent placement was uneventful. However, in the other 5 cases, respiratory failure (SpO2 < 90% and/or PaCO2 > 80 mmHg: 4 cases) or severe hypotension (systolic blood pressure < 60 mmHg: 3 cases) developed. Severe hypotension was attributed to relatively higher dose of anesthetic agents for cachexic status, or reduction in venous return following over-inflation of the lungs. Acute reduction in blood carbon dioxide levels due to extracorporeal circulation (case 4), and loss of consciousness after administration of anesthetic agents (case 2) could also have been involved in 2 cases.
Conclusions: Circulatory status must be closely monitored during anesthetic management for Dumon stent placement.
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