برونكوسكوپي و درمان اضطراري در تنگي شديد داخل تراشه

Emergency treatment in severe upper airway stenosis

Background: Tracheal and laryngeal tumoral or nontumoral lesions could lead to severe tracheal stenosis. This stenosis which is exacerbated with time, is asymptomatic at the beginning. The present study was conducted to determine the therapeutic approach in the affected individuals in two academic centers in Shaheed Beheshti University of Medical Sciences. Materials and methods: One hundred fifty one patients with severe tracheal or tracheolaryngeal stenosis underwent rigid bronchoscopy and dilatation of the airway stenosis and/or biopsy of tumoral lesions. inhalational anesthesia by halothane with or without the aid of regional block of the superior laryngeal nerves was used. Rigid bronchoscopy with occasional supplemental fiberoptic bronchoscopy was used for dilatation and biopsy of the tumors. Results: in all patients brochoscopic evaluation of the lesions were satisfactory. Eighty patients had severe respiratory distress before the procedure, of whom 77 had successfully undergone brochoscopic dilatation. Eight patients who had some degree of dyspnea in the recovery room were intubated for 1-4 days without any problem after extubation. Three patients became hypoxemic severely during brochoscopic procedure. We had to do emergency surgery to relieve airway obstruction in these 3 cases but one died due to brain hypoxemic injury, and other two recovered completely. The remaining 71 patients had mild to moderate dyspnea who had undergone brochoscopic dilatation successfully. There was no cardiac complication, however, 5 patients had increased tracheobronchial secretions after dilatation, which were treated by antibiotics. Conclusion: Brochoscopic procedure in patients with severe stenosis of trachea or tracheolaryngeal area require specific brochoscopic and anesthesiologic techniques. With the use of appropriate techniques in these critical patients brochoscopic dilatation of stenosis and diagnostic evaluation of lesions is safe. Irreversible hypoxemic complications may occur if appropriate techniques are not used.