The history was suggestive of obstructive airways disease with secondary
bronchiectasis. Physical findings were crepitations and
rhonchi all over the chest. Blood
gases were normal. Chest X-ray showed
bronchiectasis and a ventilation perfusion scan identified a tracheo-
esophageal fistula. During
anesthesia to confirm this, intubation and ventilation were difficult because of
tracheal stenosis. The
hypoventilation resulted in severe hypercarbia and
acidosis. A subsequent CT scan showed a
stenosis of 2 mm diameter and 1 cm length in the middle third of trachea,
bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous
stenosis and
tracheoesophageal fistula caused a delay with deterioration of patient from intermittent
dyspnea to
orthopnea with severe hypecarbia and
acidosis. The
anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large
foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage.
CONCLUSION: The
anesthetic consequences were peculiar to the unexpected etiology of the
stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.