Radiation Therapy Is an Effective Adjuvant Modality Following Airway Stenting for Malignant Central Airway Obstruction (CAO)

Critical central airway obstruction has always been a dreaded complication to which interventional pulmonologist commonly encounters. There have been various modalities which are used for the management and palliation, which includes mechanical coring, laser, cryoextraction, electrocautery and airway stenting. Rigid bronchoscopy with or without jet ventilation has been corner stone of therapeutics and palliation of central airway obstruction. There are only a few conditions where it is not possible to use rigid bronchoscopy. Here we report a case of metastatic tracheal tumour which presented with critical airway obstruction in a patient who had atlantoaxial instability (AAI) due to rheumatoid arthritis. Here we used endobronchial ultrasound scope (EBUS) via esophageal route, i.e. EUS-B guided approach for sampling of the tracheal tumour, and intratumoral chemotherapy was instilled in multiple sessions, which resulted in shrinking of tumour, thus relieving the critical airway obstruction. This is the first report of using EUS-B approach for intratumoral chemotherapy for tracheal tumors. Bronchoscopic intratumoral chemotherapy therapy (BITC) in tracheal tumors is also one of the options but has not been explored much and there has been a dearth of literature for it.

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Airway Procedures

10.2310/tywc.18170 ◽

2019 ◽

Author(s):

Ju-Mei Ng

Keyword(s):

Airway Obstruction ◽

Respiratory Function ◽

Anesthetic Management ◽

Rigid Bronchoscopy ◽

Intravenous Anesthesia ◽

Interventional Pulmonology ◽

Central Airway Obstruction ◽

Airway Stenting ◽

Key Words Anesthesia ◽

Central Airway

There has been a marked increase in the number and complexity of airway procedures performed both in the operating room and procedural areas. The anesthesiologist is challenged with establishing a patent shared airway and maintaining adequate gas exchange in patients with compromised airways and/or respiratory function. This review presents a general approach to the patient presenting for an airway procedure and highlights the commonly occurring complications. Airway fire, bleeding, and airway disruption or obstruction may occur. Some of the newer interventional bronchoscopic procedures are introduced, with emphasis on anesthetic implications. A more detailed discussion surrounds the anesthetic management of central airway obstruction and airway stenting. This review contains 8 figures, 5 tables, 30 references. Key Words: anesthesia for flexible bronchoscopy, anesthesia for rigid bronchoscopy, airway stenting, bronchoscopy, central airway obstruction, interventional pulmonology, total intravenous anesthesia, ventilation

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Airway Procedures

10.2310/anes.18170 ◽

2018 ◽

Author(s):

Ju-Mei Ng

Keyword(s):

Airway Obstruction ◽

Respiratory Function ◽

Anesthetic Management ◽

Rigid Bronchoscopy ◽

Intravenous Anesthesia ◽

Interventional Pulmonology ◽

Central Airway Obstruction ◽

Airway Stenting ◽

Key Words Anesthesia ◽

Central Airway

There has been a marked increase in the number and complexity of airway procedures performed both in the operating room and procedural areas. The anesthesiologist is challenged with establishing a patent shared airway and maintaining adequate gas exchange in patients with compromised airways and/or respiratory function. This review presents a general approach to the patient presenting for an airway procedure and highlights the commonly occurring complications. Airway fire, bleeding, and airway disruption or obstruction may occur. Some of the newer interventional bronchoscopic procedures are introduced, with emphasis on anesthetic implications. A more detailed discussion surrounds the anesthetic management of central airway obstruction and airway stenting. This review contains 8 figures, 5 tables, 30 references. Key Words: anesthesia for flexible bronchoscopy, anesthesia for rigid bronchoscopy, airway stenting, bronchoscopy, central airway obstruction, interventional pulmonology, total intravenous anesthesia, ventilation

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