Anesthesia for bronchoscopic amniotic membrane grafting to treat non-healing bronchial dehiscence

• 作者: D John Doyle Taoyuan Robert Feng Thomas R Gildea
• 来源期刊: 世界麻醉学杂志
• 学科: 医学
• 关键词: BRONCHIAL DEHISCENCE Amniotic membrane GRAFTING BRONCHOSCOPY Lung transplantation ANESTHESIA
• 年，卷（期）: 2015,（2）
• 页码范围: 39-43
• 页数: 5页
• 分类号: R

摘要

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.