Intravenous rapid sequence induction of anesthesia for rigid bronchoscopic dilatation in patients with severe postintubation tracheal stenosis

Rigid broncoscopic dilatation is the lifesaving method for management of severe tracheal stenosis carried out under general anesthesia. However, for both anesthesiologist and bronchosco-pist, this procedure represents a most challenging practice. Inhalational induction which maintains spontaneous ventilation is commonly recommended in these patients. However, it needs a long time to reach the appropriate levels of anesthesia, and also airway instrumentation can precipitate coughing and complete airway obstruction. This paper describes our experience with rigid bronchoscopic dilation procedures performed with intravenous rapid induction of anesthesia in patients with severe postintubation tracheal stenosis. We conducted a retros-pective chart review of one hundred patients with severe post intubation tracheal stenosis who underwent rigid bronchoscopy for dilation of stenosis under general anesthesia at Masih Daneshvari and Kasra hospitals from Nov. 2011 to Sep. 2012. A rapid sequence induction of anesthesia was performed by intravenous injection of sodium thiopental and succinylcholine. Then an appropriate size of rigid bronchoscope was introduced into the trachea. If the airway was secured, dilatation of stenosis was done serially by different sizes of rigid bronchoscopes. Demographic, stenosis characteris-tics, and complications were recorded. There were 76 males and 24 females with mean age of 31.5±17.5 years. Following induction of anesthesia, the airway was rapidly secured in the first attempt with rigid bronchoscope in 97 patients. In 3 patients insertion of rigid bronchoscope was encountered with some problems, although airway control was done well and no major complications occurred. The intravenous rapid sequence induction of anesthesia by use of succinylcholine is safe for rigid brochoscopic dilatation in patients with severe post intubation tracheal stenosis. Close communication between the anesthesia and surgical teams are mandatory for the safe outcome of this procedure.