• Airway stents
    • Placed for both malignant and non-malignant causes
      • Primary endoluminal carcinoma
      • Oesophageal carcinoma
      • Mediastinal tumours
      • Lymphadenopathy
      • Lymphoma
      • Tracheomalacia
      • Goitre
    • Can be silicone or metal stents
      • Silicone easier to remove
      • Metal stents can be covered or uncovered with polyurethane
    • Implications of intrathoracic malignancy
      • Cachexia and malnutrition
      • Eaton-Lambert syndrome (sensitive to NMBDs)
      • Endocrine abnormalities
        • Hyperparathyroidism
        • SIADH
        • Cushing's syndrome
      • Previous CXT
        • Venous thrombosis
        • Cardiac S/E
      • Previous RXT can cause fibrosis of soft tissues
      • Airway obstruction above/below the cords
      • Innervation of the vocal cords damaged
      • Immunosuppression
      • SVC obstruction
    • Management
      • Upper airway obstruction
        • Based on maintaining airway patency and muscle tone before intubation
      • Lower airway
        • Patients for stenting have lesions BELOW the cords
      • Flow volume loops may help
      • Systematic review of radio graphic images is more valuable
    • Anaesthesia
      • Lesions below the cords rarely present with intubation problems
      • BMV is usually successful
      • Surgical airway will not overcome ventilation crisis due to the lesion
      • Limit inspiratory pressure to avoid gas trapping and allow adequate expiration
      • Rigid bronchoscopy is the only reliable rescue
      • Surgeon will have preference of rigid vs flexible bronchoscopy
      • Bronchoscopy
        • Rigid
          • Requires NMBDs
          • Severe surgical stimulus
          • IV maintenance (remi/propofol)
          • No control of FiO₂
          • Jet ventilation
          • BIS may be helpful
        • Flexible
          • Can be passed down ETT
          • Moderate surgical stimulus
          • Not as good surgical field
          • Volatile maintenance possible
          • FiO₂ controllable
      • Complications
        • Airway obstruction due to oedema or stent malplacement
        • Airway perforation (pneumothorax, pneumomediastinum)
      • Post op
        • Nebulised adrenaline and steroids can be helpful for oedema
        • Heliox
        • Central airway syndrome
          • Due to blood, clots or old sputum
          • Treated by rigid bronchoscopy
        • Halitosis common
    • Anaesthesia for unrelated surgery: try to keep clear of the stent if possible, they can be dislodged, damaged or extra luminal tracts can form. If intubation is necessary, fibreoptic bronchoscope should be used to check position
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/10/2/53.full.pdf