Dexmedetomidine for Rigid Bronchoscopy in an Infant with Tracheal Web after Ventricular Septal Defect Patch Repair

We report herein successful rigid bronchoscopy with preserved spontaneous breathing of a 54-day-old infant with tracheal web associated with previous ventricular septal defect (VSD) repair. We considered the use of dexmedetomidine in conjunction with intermittent ketamine from the following three clinical aspects. First, this infant was suffering from respiratory distress with chest retraction, the cause of which was not revealed by a computerized scan of the neck and chest. Second, the patient was scheduled for rigid bronchoscopy, which is accompanied by brief but strong stimulation. Third, this infant underwent congenital VSD heart repair approximately 1 month earlier.

Airway obstruction due to post intubation circumferential tracheal web formation: A case report

Tracheal stenosis is well known complication of endotracheal intubation. However, severe post intubation tracheal stenosis that requires interventional bronchoscopy or tracheal surgery is un-common. Necrosis induced by cuff pressure-related loss of regional blood flow is the central injury leading to postinubation tracheal stenosis. The large volume, low pressure cuff of endo-tracheal tubes have markedly reduced the occurrence cuff-induced injury. However, in any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, possibility of tracheal stenosis should be considered. We report a case of severe tracheal stenosis by tracheal web formation a 52-year-old following ventilator therapy for ARDS.