Anaesthetic management of tracheobronchial disruption during oesophagectomy

  • Tripat Bindra Sri Guru Ram Das Institute of Medical Sciences & Research
  • Ruchi Gupta Sri Guru Ram Das Institute of Medical Sciences & Research
  • Geetanjali Pushkarna Sri Guru Ram Das Institute of Medical Sciences & Research
Keywords: Esophagectomy, tracheobronchial disruption, thoracotomy, emphysema, iatrogenic, microlarygeal tube

Abstract

Although tracheobronchial injuries occur rarely during oesophagectomy, the outcome of such injuries is mostly unfavourable. We report the case of a 50-year-old female, American Society of Anesthesiologists (ASA) class 1, who suffered a tracheobronchial injury during transthoracic oesophagectomy. The defect was repaired with an intercostal muscle flap but tracheobronchial disruption occurred again on extubation. As a result, she developed a profuse air leak postoperatively, through the bilateral thoracic and abdominal drains. A second surgical procedure using a single-lumen endotracheal tube was undertaken. During the procedure the patient deteriorated, owing to an increase in the tracheal rent, which resulted in a severe impairment of ventilation. This crisis was initially managed through advancement of the endotracheal tube into the left main bronchus. Subsequently, oxygenation and ventilation of both lungs was achieved by intubating both the main bronchi with microlaryngeal tubes, with the patient in the left lateral position.

Author Biographies

Tripat Bindra, Sri Guru Ram Das Institute of Medical Sciences & Research
MD Anaesthesia Assistant Professor Department of Anaesthesia & Critical Care Sri Guru Ram Das Institute of Medical Sciences & Research Amritsar
Ruchi Gupta, Sri Guru Ram Das Institute of Medical Sciences & Research
MD DNB Anaesthesia Professor & Head Department of Anaesthesia & Critical Care Sri Guru Ram Das Institute of Medical Sciences & Research Amritsar
Geetanjali Pushkarna, Sri Guru Ram Das Institute of Medical Sciences & Research
MD Anaesthesia Senior Resident Department of Anaesthesia & Critical Care Sri Guru Ram Das Institute of Medical Sciences & Research Amritsar
Published
2011-07-12
Section
Case Studies