Anaesthetic management of tracheobronchial disruption during oesophagectomy

Although tracheobronchial injuries occur rarely during oesophagectomy, the outcome of such injuries is mostly unfavourable. We report the case of a 50-year-old female, American Society of Anesthesiologists (ASA) class 1, who suffered a tracheobronchial injury during transthoracic oesophagectomy. The defect was repaired with an intercostal muscle flap but tracheobronchial disruption occurred again on extubation. As a result, she developed a profuse air leak postoperatively, through the bilateral thoracic and abdominal drains. A second surgical procedure using a single-lumen endotracheal tube was undertaken. During the procedure the patient deteriorated, owing to an increase in the tracheal rent, which resulted in a severe impairment of ventilation. This crisis was initially managed through advancement of the endotracheal tube into the left main bronchus. Subsequently, oxygenation and ventilation of both lungs was achieved by intubating both the main bronchi with microlaryngeal tubes, with the patient in the left lateral position.