Application Of MAC Combined With Tracheal Stents In Tracheal Stenosis

Objectives:The value of MAC (monitored anesthesia care) with ventilation duct–assisted tracheal stenosis in clinically treating benign and malignant trachealstenosis was discussed.Methods:27patients with tracheal stenosis hospitalized in the hospital fromSeptember2012to September2014, including19males and8females,6and21patients with benign and malignant tracheal stenosis respectively whose ageranged from23to61and mean age was49, were treated through MCA-assistedtracheal stent implantation by a stent with memory Ni-Ti alloy and digitalsubtraction angiography in blood vessels after establishment of effectiveventilation with ventilation catheter. The state and cooperation of patientsreceiving MAC-assisted after establishment of effective ventilation withventilation catheter tracheal stent implantation were observed to ensure if theywere awake, their respiration was inhibited, felt painful or coughed, etc. Thechanges to their KPS, MRC and SpO2before and after operation werecompared. Paired-samples T tests were performed for pre-operative andpost-operative KPS, MRC and SpO2, and there would be statistical significance in case that the value of P was below0.001. Pertinent imaging examinationswere conducted for patients before and after operations respectively, in order tocompare changes to the parts with stenosis during these examinations.Attention was paid to observe if patients suffered complications after operationuntil they were discharged from the hospital. Besides, a follow-up visit wasconducted for patients.Tracheal stent implantation was performed for27patients under MAC afterestablishment of effective ventilation with ventilation catheter. All of patientswere awake under MAC without respiratory inhibition and could well obeydoctors’ orders. They neither felt rather painful nor had strong responses. Onlya small number of patients slightly coughed. Compared with pre-operation,significant increased was observed in KPS for all patients after operation untilthey were discharged. The KPS was50at the maximum,20at the minimumand35.55on average before operation for27patients. However, it was90atthe maximum,60at the minimum and76.29on average after patients’operation until they were discharged. By comparing KPS of patients before andafter operation, t was calculated to be-79.32and found to be statisticallysignificant as p was below0.001. MRC declined. For27patients, the MRC was4.0at the maximum,3.0at the minimum and3.70on average before operation.In the period after operation until discharge, the MRC was3.0at the maximum,2.0at the minimum and2.33on average for all patients. After comparing MRCfor all patients before and after operation, t was determined to be9.60and p was found to be below0.001, so there was statistical significance. An increasewas observed in SpO2. Among27patients, the SpO2was93%at the maximum,87%at the minimum and90.63%on average. After patients’ operation untildischarge, the SpO2was94%at the minimum,100%at the maximum and97.70%on average. By comparing SpO2for all patients before and afteroperation, t was determined to be-26.03and was statistically significantbecause p was lower than0.001. From the comparison of chest CT before andafter operation, coronary arteries with stenosis were found to be basicallyrecovered. Only three out of all patients suffered from restenosis following thetracheal stent implantation. They received MAC-assisted tracheal stentimplantation in the department over again after their hospitalization. Amongthese three patients, restenosis appeared behind the stent of a patient, becauserestenosis occurred at the distal end of the stent. After the tracheal stentimplantation, ruckling and dyspnea were found in the patient. After severaldepartments’ diagnosis, a tracheostomy was performed with a tracheal stentby doctors from the otolaryngological department. After the operation, thepatient kept steady vital signs, turned better and was discharged from thehospital. The left patients suffered from no severe complications.Conclusion:Patients’ state and cooperation during tracheal stent implantation under MACwith ventilation catheter were observed. Changes to KPS, MRC, SpO2andimaging were compared for patients before and after operation. Besides, follow-up visits were conducted for patients. At last, tracheal stent implantationwas proven to be effective for treating tracheal stenosis fast with a high successrate and few complications. The tracheal stent implantation under MAC withventilation catheter is characterized by low risks and little pain, so it is worthyof widespread clinic use.