Anesthesia and airway management for removing pulmonary self-expanding metallic stents

Doyle, D. John; Abdelmalak, Basem; Machuzak, Michael; Gildea, Thomas R.

doi:10.1016/j.jclinane.2008.11.010

« Previous Next »Journal of Clinical Anesthesia
Volume 21, Issue 7 , Pages 529-532, November 2009

Anesthesia and airway management for removing pulmonary self-expanding metallic stents☆

D. John Doyle, MD, PhD, FRCPC (Professor and Staff)
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA
- Corresponding author. Department of General Anesthesiology – E31, Cleveland Clinic, Cleveland, OH 44195, USA. Tel.: +1 216 444 1927; fax: +1 216 444 2294.
Basem Abdelmalak, MD (Staff)
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA
Michael Machuzak, MD (Staff)
- Department of Pulmonary, Allergy and Critical Care Medicare, Cleveland Clinic, Cleveland, OH 44195, USA
Thomas R. Gildea, MD (Staff)
- Department of Pulmonary, Allergy and Critical Care Medicare, Cleveland Clinic, Cleveland, OH 44195, USA

Received 24 March 2008; received in revised form 13 October 2008; accepted 10 November 2008. published online 09 September 2009.

Abstract

The use of bronchoscopically placed self-expanding metallic stents (SEMS) and silastic stents in patients suffering from tracheobronchial stenosis or similar problems has proven to be an important clinical option. When complications occur, it may be necessary to remove the device. Removal of a SEMS is usually performed during general anesthesia with muscle relaxation and positive pressure ventilation, often using total intravenous anesthesia. Airway management depends on stent type and location. Intubating patients' tracheas with a tracheal stent requires special caution, as it risks damaging tissue and dislodging the stent distally. Potential complications with removal include tracheal disruption, retained stent pieces, mucosal tears, re-obstruction requiring new stent placement, the need for postoperative ventilation, pneumothorax, damage to the pulmonary artery, and death.

Keywords: Airway management, Lung transplantation, Metallic stent, Silastic stent