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Anesthesia for insertion of a Dumon stent in a patient with a large tra-cheo-esophageal fistula

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Abstract

Purpose

To present the anesthetic management for the insertion of a Dumon silicon stent to the trachea of a patient with a large tracheo-esophageal fistula. The aim of the stent insertion was to seal the fistula in order to prevent aspiration of esophageal content and subsequent pneumonitis,

Clinical features

A 45-yr-old man with a large tracheo-esophageal fistula was scheduled for the insertion of the Dumon stent. Since placement of the stent necessitates the insertion of a rigid bronchoscope, under general anesthesia, with its tip just proximal to the fistula, controlled ventilation was expected to be difficult to achieve because of the diversion of oxygen through the large fistula to the esophagus. We successfully ventilated the lungs, after the fistula was sealed using a large balloon which was inserted in the esophagus, and the stent insertion was completed uneventfully.

Conclusion

Anesthesia for procedures involving the central airway is challenging. This report describes a simple and practical method to facilitate ventilation by temporary seal of a tracheo-esophageal fistula using a modified esophageal balloon.

Résumé

Objectif

Présenter l’anesthésie utilisée pendant l’insertion d’un tuteur au silicone Dumon dans la trachée d’un patient pour fermer une importante fistule trachéo-œsophagienne et ainsi empêcher une aspiration du contenu œsophagien et une pneumopathie consécutive.

Éléments cliniques

Un homme de 45 ans qui présentait une grande fistule trachéo-œsophagienne a été admis pour l’insertion d’un tuteur Dumon. Comme sa mise en place nécessite l’insertion, sous anesthésie générale, d’un broncoscope rigide dont la pointe est introduite tout près de la fistule, nous nous attendions à ce que la ventilation contrôlée soit difficile à cause de la possibilité pour l’oxygène de passer dans l’oesophage. Nous avons réussi la ventilation après la fermeture de la fistule en utilisant un gros ballon que nous avons inséré dans l’œsophage, et l’insertion du tuteur a été réalisée sans incident.

Conclusion

C’est un défi de procéder à l’anesthésie lors d’interventions aux voies aériennes centrales. Le présent article décrit une méthode simple et pratique de faciliter la ventilation en fermant temporairement une fistule trachéo-œsophagienne avec un ballon œsophagien modifié.

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Author information

Correspondence to Takefumi Inada.

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Inada, T., Umemoto, M., Ohshima, T. et al. Anesthesia for insertion of a Dumon stent in a patient with a large tra-cheo-esophageal fistula. Can J Anaesth 46, 372 (1999). https://doi.org/10.1007/BF03013231

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Keywords

  • Esophageal Atresia
  • Stent Insertion
  • Tracheal Stenosis
  • Rigid Bronchoscope
  • Fibreoptic Bronchoscopy