The causes of tracheobronchial obstruction are listed in Table 1
Table 1 Causes of tracheobronchial obstruction
Strictures following previous prolonged tracheal intubation represent a common cause of obstruction. Primary tumors of the trachea (cylindromas) are uncommon and are outnumbered by invasive bronchial tumors (bronchogenic carcinoma, esophageal carcinoma).
Tracheomalacia should be considered in any patient with a large thyroid lesion. Obstructive symptoms may present postoperatively after extubation and when mucosal edema is progressive. Anterior mediastinal masses are commonly associated with airway compression and anesthetic planning is mandatory ( Fig 1).
Fig. 1 Flowchart of a plan for preoperative evaluation of the patient with suspected tracheobronchial obstruction: + positive finding; - negative work-up. (Adapted with permission from Neuman. §i,§L (1984).)
Complete tracheal obstruction presents a life-threatening emergency. Bronchial obstruction may be better tolerated, but can prove life threatening in the presence of diminished cardiopulmonary reserve. Incomplete bronchial obstructions may be associated with hemodynamic collapse secondary to 'ball-valve' obstruction.
Airway collapse from partially obstructing tracheobronchial lesions can present during anesthesia induction, maintenance, or extubation. Patients may subsequently provide a history of respiratory symptoms, the significance of which was missed on initial evaluation.
Tracheal stenosis may be misdiagnosed as asthma; clues to its presence are recurrent attendances with failure to respond to bronchodilator therapy or with postural aggravation of symptoms. Some patients may present with recurrent respiratory arrest.
Patients with a known mediastinal mass or previous tracheostomy, or who have previously undergone prolonged ventilation, should be considered at risk of tracheal narrowing.
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