Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. Jul 27, 2015; 4(2): 39-43
Published online Jul 27, 2015. doi: 10.5313/wja.v4.i2.39
Anesthesia for bronchoscopic amniotic membrane grafting to treat non-healing bronchial dehiscence
Taoyuan Robert Feng, Thomas R Gildea, D John Doyle
Taoyuan Robert Feng, Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, United States
Thomas R Gildea, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, United States
D John Doyle, Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates
Author contributions: Feng TR designed and drafted the case report and revised the manuscript; Gildea TR performed the bronchoscopic procedure and provided manuscript revisions; Doyle DJ provided anesthesia for the procedure and revised the manuscript.
Institutional review board statement: The Cleveland Clinic Foundation Institutional Review Board indicated that they do not require consent or approval for case reports where the patient is not identifiable.
Informed consent statement: Despite repeated attempts, we were unable to reach the family of the patient, who is now deceased. The Cleveland Clinic Foundation Institutional Review Board indicated that consent it not required from deceased patients.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. D John Doyle, MD, PhD, Chief, Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates. djdoyle@hotmail.com
Telephone: +971-52-6997627 Fax: +971-2-4108374
Received: February 2, 2015
Peer-review started: February 2, 2015
First decision: March 6, 2015
Revised: April 24, 2015
Accepted: May 7, 2015
Article in press: May 8, 2015
Published online: July 27, 2015
Processing time: 174 Days and 17 Hours
Abstract

Airway complications after lung transplantation remain a significant cause of morbidity and mortality. Many of these occur at the anastomotic sites, which are susceptible due to poor collateral circulation. Of the possible complications, bronchial dehiscence is particularly formidable. These cases have been successfully treated bronchoscopically with metallic stents, which likely promote healing through granulation tissue formation. However, limited options exist in cases where the dehiscence fails to heal following stent placement. Here, we present the case report of a 65-year-old male who developed bronchial dehiscence status post bilateral lung transplantation for idiopathic pulmonary fibrosis that failed to heal with simple stent placement. Eventually, the patient underwent amniotic membrane grafting with stenting as a novel therapy for non-healing bronchial dehiscence, for which we describe the anesthetic management. His anesthetic plan included inhalational induction with sevoflurane, propofol infusion for total intravenous anesthesia, rocuronium for muscle relaxation, and closed-circuit assisted ventilation. His existing tracheostomy was used as the airway for oxygenation and induction. In summary, our anesthetic plan for the lung transplant patient was effective; future amniotic membrane grafting for bronchial dehiscence through bronchoscopy may follow a similar technique. Ultimately, the choice of anesthesia in this patient population requires judicious consideration of the requirements of the procedure as well as the pathophysiology of the transplanted lung.

Keywords: Bronchial dehiscence; Amniotic membrane; Grafting; Bronchoscopy; Lung transplantation; Anesthesia

Core tip: Bronchial dehiscence is a significant airway complication following lung transplantation and most commonly occurs at anastomotic sites due to poor collateral perfusion. This complication is often difficult to treat, especially when widespread. Severe disease has been treated with the temporary placement of metallic stents within the airway to promote healing, but limited options exist when stenting fails. This case report presents the anesthetic considerations for a lung transplant patient undergoing bronchoscopic placement of an amniotic membrane graft as a novel solution for non-healing bronchial dehiscence after multiple failed attempts with metallic stent placement.