Anesth Analg 2003;97:1856
© 2003 International Anesthesia Research Society
LETTERS TO THE EDITOR
Unique Anesthetic Management of a Patient with a Large Tracheoesophageal Fistula Using Fiberoptic Bronchoscopy
Takafumi Horishita, MD,
Junichi Ogata, MD, and
Kouichiro Minami, MD PhD
Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
To the Editor:
Tracheoesophageal fistulas (TEF) occur as a result of malignant disease and it is difficult to prevent regurgitation via the fistula (1–5). Here, we report the unique management of a large fistula (2 cm ID) at the right carina using a bronchofiberscope, which developed in a 63-year-old man after radiotherapy following left total pneumectomy. The TEF was situated at the right carina, and his proximal esophagus was almost completely obstructed (Fig. 1). He was scheduled for an esophageal bypass with colonic interposition to improve his dysphagia and prevent pulmonary aspiration. General anesthesia was induced IV with propofol, fentanyl, and succinylcholine. Since the TEF was situated at the right carina, we inserted a 32F left double-lumen tube (SheribronchoTM, Tyco, Tokyo, Japan) into the right bronchus under observation, the TEF through the right tracheal lumen. After inserting the tube into the right bronchus, we were able to observe the TEF using the bronchofiberscope in the right tracheal lumen, which allowed us to monitor the position of the cuff and fistula continuously. Moreover, any material regurgitated via the fistula during the operative procedure was aspirated to prevent pulmonary aspiration via the right bronchus. We completely prevented any gastric contents from entering the trachea through the TEF. Our procedure for this patient is useful for patients with TEF.
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Figure 1. Panel A shows that the position of the tracheoesophageal fistula (TEF) before intubation using a model and the position of the 32F left double-lumen tube (SheribronchoTM, Tyco, Tokyo, Japan) inserting into the right bronchus using a bronchofiberscope to observe the TEF through the right tracheal lumen (panel B). In panel C, the view is an overview above the carina via the bronchial lumen before insertion of the bronchial lumen into the right bronchus. The arrow (a) indicates the TEF. In panel D, the view is an overview via the right tracheal lumen after inserting a left double-lumen tube into the right bronchus. We were able to observe the TEF (a) at the upper of the cuff of a bronchial lumen (b).
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