Revue des maladies respiratoires
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Post intubation tracheal stenosis (STPI) is a rare but serious complication of tracheal intubation and/or tracheotomy. The epidemiology has changed over the last twenty years. The diagnosis is sometimes difficult to establish on clinical grounds alone. ⋯ Rigid bronchoscopy enables mechanical dilatation of the STPI which can be associated with Nd-Yag laser ortracheal endoprostheses. In certain cases interventional bronchoscopy may be curative. However in all cases the management of such lesions remains multi-disciplinary involving pulmonologists, thoracic surgeons, otolaryngologists and anaesthetists.
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Interventional rigid bronchoscopy requires the same careful anesthetic management as any type of surgery. Furthermore, access to airways for both endoscopist and anaesthetist raises difficult problems. Hypoventilation with its consequences is a major risk, especially for patients with impaired ventilatory capacity. ⋯ Flexible fiberoptic bronchoscopy is systematically performed before extubation. Interventional rigid bronchoscopy is ideally performed in an operating room or an adjacent area or in an intensive care unit in case of complication. Postoperative supervising in a recovery room is mandatory.