Introduction: Laryngotracheal stenosis is a congenital or acquired narrowing of the airway that may affect the glottis, subglottis or trachea.Tracheal stenosis can present very insidiously or as a catastrophic episode. . Surgery is the most effective treatment, although the procedure is challenging to the anaesthesiologists.We describe successful management of a case of recurrent tracheal stenosis without cardiopulmonary bypass.

Case Report:

A 21 year old male weighing 66 kg was admitted as a follow up case of tracheal repair for tracheal stenosis. He had history of head injury 2 year back and tracheostomy was done at that time. After 1 year, patient was diagnosed with tracheal stenosis and tracheal repair was done with pericardial patch . Later he had multiple episodes of respiratory distress which were managed conservatively.

CT scan thorax with virtual bronchoscopy showed tracheal stenosis 3.1 cm above carina involving 60% -70% diameter and length of stenosed segment was 9.7 mm. Now he was admitted with progressively increasing respiratory distress and he was intubated in emergency with ETT no. 5.0 mm ID and ETT was changed to 6.0mm in O.T. as larger ET tube was not passing through and he was kept on ventilatory support. Surgery was performed through sternotomy and pericardial patch tracheoplasty was done. When stenosed segment was resected, jet ventilation was done through oral ETT. When saturation was not maintained, right bronchial intubation with ETT no. 6.0 mm ID was done by surgeons through the stoma and ventilation was done through bain’s circuit.

After repair of tracheal segment, proximal ETT was changed to no. 7.5 mm ID over a ET tube exchanger and advanced gently to cross the repaired segment and was ventilated . Post operative ventilation was continued for 6 hours and patient was extubated when fully conscious and discharged after 10 days.

Conclusion : surgical resection is life saving for the patients with critical lower tracheal stenosis and how to ensure effective gas exchange is crucial to the anesthetic management.This method can be an alternative approach to tracheal repair without the need of cardiopulmonary bypass.