Endoscopic removal of a self-expanding metallic airway stent: A case report

Abstract

Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-year-old man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure (ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external (wearable) cardiac defibrillator (Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion (total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 iGel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.

Keywords: Airway management, Flexible bronchoscope, Rigid bronchoscopy, Self-expanding metallic stents, Supraglottic airway, Total intravenous anesthesia

Core tip: Endoscopic removal of self-expanding metallic airway stents may be necessitated by the formation of extensive granulation tissue, but can pose difficult challenges to both the proceduralist and the anesthesiologist. Total intravenous anesthesia utilizing a propofol infusion and rocuronium for neuromuscular blockade can be useful in such cases. Induction of general anesthesia with etomidate can be useful in patients with poor ventricular function. Airway management can be achieved with an iGel supraglottic airway and later, rigid bronchoscopy.