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Behouche A, Sebestyen A, Guillet L, Durand H, Chaffanjon P, Bedague D. Pre-emptive veno-arterial ECMO in a giant compressive goiter-related difficult airway: A case report. Artif Organs 2024; 48:683-685. [PMID: 38385689 DOI: 10.1111/aor.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
A 64-year-old patient required emergency surgery with high risk of intubation failure, without any possibility to perform neither a direct transtracheal access nor VV-ECMO canulation. The patient was managed thanks to a VA-ECMO despite the absence of cardiac function impairment. This report describes perioperative challenges and management of this unconventional case with favorable outcome.
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Affiliation(s)
- Alexandre Behouche
- Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alpes, Grenoble, France
| | - Alexandre Sebestyen
- Department of Cardiac Surgery, University Hospital of Grenoble Alpes, Grenoble, France
| | - Laura Guillet
- Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alpes, Grenoble, France
| | - Herve Durand
- Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alpes, Grenoble, France
| | - Philippe Chaffanjon
- Department of Thoracic, Vascular and Endocrine Surgery, University Hospital of Grenoble Alpes, Grenoble, France
- GIPSA-Lab (UMR 5216), Department of PSD - MOVE, University Grenoble Alpes, Grenoble, France
| | - Damien Bedague
- Department of Anesthesiology and Critical Care, University Hospital of Grenoble Alpes, Grenoble, France
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2
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Attou R, Redant S, Velissaris D, Kefer K, Abou Lebdeh M, Waterplas E, Pierrakos C. Extracorporeal membrane oxygenation versus invasive ventilation in patients with COVID-19 acute respiratory distress syndrome and pneumomediastinum: A cohort trial. Artif Organs 2024. [PMID: 38660764 DOI: 10.1111/aor.14760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/31/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Patients with severe respiratory failure due to COVID-19 who are not under mechanical ventilation may develop severe hypoxemia when complicated with spontaneous pneumomediastinum (PM). These patients may be harmed by invasive ventilation. Alternatively, veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may be applied. We report on the efficacy of V-V ECMO and invasive ventilation as initial advanced respiratory support in patients with COVID-19 and acute respiratory failure due to spontaneous PM. METHODS This was a retrospective cohort study performed between March 2020 and January 2022. Enrolled patients had COVID-19 and acute respiratory failure due to spontaneous PM and were not invasively ventilated. Patients were treated in the intensive care unit (ICU) with invasive ventilation (invasive ventilation group) or V-V ECMO support (V-V ECMO group) as the main therapeutic option. The primary outcomes were mortality and ICU discharge at 90 days after ICU admission. RESULTS Twenty-two patients were included in this study (invasive ventilation group: 13 [59%]; V-V ECMO group: 9 [41%]). The V-V ECMO strategy was significantly associated with lower mortality (hazard ratio [HR] 0.33 [95% CI 0.12-0.97], p = 0.04). Five (38%) patients in the V-V ECMO group were intubated and eight (89%) patients in the invasive ventilation group required V-V ECMO support within 30 days from ICU admission. Three (33%) patients in the V-V ECMO group were discharged from ICU within 90 days compared to one (8%) patient in the invasive ventilation group (HR 4.71 [95% CI 0.48-45.3], p = 0.18). CONCLUSIONS Preliminary data suggest that V-V ECMO without invasive ventilation may improve survival in COVID-19-related acute respiratory failure due to spontaneous PM. The study's retrospective design and limited sample size underscore the necessity for additional investigation and warrant caution.
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Affiliation(s)
- Rachid Attou
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Sebastien Redant
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Keitiane Kefer
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Mazen Abou Lebdeh
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Eric Waterplas
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Charalampos Pierrakos
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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3
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:207-247. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitary Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Emergency Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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4
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Daubenspeck DK. Invited Commentary: "Venovenous Extracorporeal Membrane Oxygenation for the Difficult Airway-Advocating for a Cautious Approach". J Cardiothorac Vasc Anesth 2023; 37:2657-2659. [PMID: 37723021 DOI: 10.1053/j.jvca.2023.08.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Danisa K Daubenspeck
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
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5
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Tsurumachi N, Saito T, Asai T. Extracorporeal membrane oxygenation support during thoracic surgery in a patient with thoracic pneumothorax and severe interstitial pneumonia. Minerva Anestesiol 2023; 89:1058-1060. [PMID: 37432315 DOI: 10.23736/s0375-9393.23.17446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Affiliation(s)
- Naoi Tsurumachi
- Department of Anesthesiology, DMU Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan -
| | - Tomoyuki Saito
- Department of Anesthesiology, DMU Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
| | - Takashi Asai
- Department of Anesthesiology, DMU Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
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Maxwell C, Forrest P. The role of ECMO support in airway procedures. BJA Educ 2023; 23:248-255. [PMID: 37389276 PMCID: PMC10300492 DOI: 10.1016/j.bjae.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/08/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- C. Maxwell
- Royal Prince Alfred Hospital, Sydney, Australia
| | - P. Forrest
- Royal Prince Alfred Hospital, Sydney, Australia
- Sydney University Medical School, Sydney, Australia
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7
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Karam C, Abou Nafeh N, Aouad MT, Siddik‐Sayyid S, Kaddoum R, Zeeni C, Anka S, Shaya B, Khalili A. Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report. Clin Case Rep 2023; 11:e7509. [PMID: 37323276 PMCID: PMC10264909 DOI: 10.1002/ccr3.7509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
Surgical resection of obstructive tracheal tumors can be challenging to cardiothoracic surgeons and anesthesiologists. It is often difficult in these cases to maintain oxygenation by face mask ventilation during induction of general anesthesia. Also, the extent and location of these tracheal tumors can preclude conventional induction of general anesthesia and subsequent successful endotracheal intubation. Peripheral cardiopulmonary bypass (CPB) under local anesthesia and mild intravenous sedation may be safe to support the patient until securing a definitive airway. We describe a case of a 19-year-old female with a tracheal schwannoma, who developed differential hypoxemia (Harlequin, or North-South, syndrome) after institution of awake peripheral femorofemoral venoarterial (VA) partial CBP.
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Affiliation(s)
- Cynthia Karam
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Nancy Abou Nafeh
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Marie T. Aouad
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Sahar Siddik‐Sayyid
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Roland Kaddoum
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Carine Zeeni
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Sandra Anka
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Bashir Shaya
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Amro Khalili
- Department of Anesthesiology and Pain MedicineAmerican University of Beirut Medical CenterBeirutLebanon
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8
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Tan D, Zhang X. Awake Fiberoptic Nasotracheal Intubation and Anesthetic Management of a Patient With a Compressed and Deviated Airway From a Massive Thyroid Goiter: A Case Report. Cureus 2023; 15:e35278. [PMID: 36968903 PMCID: PMC10036196 DOI: 10.7759/cureus.35278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
Difficult airway management is a challenge for anesthesiologists, requiring proper assessment, planning, and sometimes a multidisciplinary approach to establish a secure airway. Here we present a case where the patient had a large thyroid goiter with significant tracheal compression. Due to the large size of the thyroid mass and the location of tracheal narrowing, fiberoptic intubation appeared to be challenging, and a surgical airway was not a viable option to obtain a secure airway for a total thyroidectomy. This case report discusses awake fiberoptic intubation and intraoperative anesthetic management of a patient with known airway compression and explores the alternative method for obtaining a definitive airway through venovenous extracorporeal membrane oxygenation.
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9
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Liu IL, Chou AH, Chiu CH, Cheng YT, Lin HT. Tracheostomy and venovenous extracorporeal membrane oxygenation for difficult airway patient with carinal melanoma: A case report and literature review. World J Clin Cases 2022; 10:13088-13098. [PMID: 36569026 PMCID: PMC9782950 DOI: 10.12998/wjcc.v10.i35.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anesthesia for tracheal tumor resection is challenging, particularly in patients with a difficult upper airway. We report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation (VV-ECMO) support for rigid bronchoscopy-assisted tumor resection.
CASE SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope episodes. Chest computed tomography revealed a 3.0-cm tracheal mass at the carinal level, causing 90% tracheal lumen obstruction. Flexible bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal obstruction. Because of aggravated symptoms, emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby VV-ECMO. Due to limited mouth opening, tracheostomy was necessary for rigid bronchoscopy access. While transferring the patient to the operating table, sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation support. Femoral and internal jugular vein were catheterized to facilitate possible VV-ECMO deployment. During tracheostomy, progressive desaturation developed and VV-ECMO was instituted immediately. After tumor resection and tracheal stenting, VV-ECMO was weaned smoothly, and the patient was sent for intensive postoperative care. Two days later, he was transferred to the ward for palliative immunotherapy and subsequently discharged uneventfully.
CONCLUSION In a difficult airway patient with severe airway obstruction, emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving, and ECMO can be weaned smoothly after tumor excision. During anesthesia for patients with tracheal tumors causing critical airway obstruction, spontaneous ventilation should be maintained at least initially, and ECMO deployment should be prepared for high-risk patients, such as those with obstructive symptoms, obstructed tracheal lumen > 50%, or distal trachea location.
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Affiliation(s)
- I-Liang Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chien-Hung Chiu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Huan-Tang Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
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10
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Diagnostic Efficacy and Clinical Value of Ultrasonography in Difficult Airway Assessment: Based on a Prospective Cohort Study. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4706438. [PMID: 36082062 PMCID: PMC9433204 DOI: 10.1155/2022/4706438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Objective. A case-control study was conducted to explore the diagnostic efficacy and clinical value of ultrasound in difficult airway assessment. Methods. A total of 220 patients undergoing elective surgery under general anesthesia were prospectively enrolled in our hospital from April 2018 to April 2021. General data were collected one day before operation, including sex, age, height, weight, body mass index (BMI), modified Mallampati test (MMT), inter-incisor distance (IID) and thyromental distance (TMD), the upper lip bite test (ULBT), and thyromental height (TMH). DSH, DSE, DSV, HMD, and tongue width and thickness were measured by ultrasound in the supine position before anesthesia induction on the day of operation. The above data were measured by the same anesthesiologist. After anesthesia, the patients were exposed to laryngoscope by the same senior doctor who did not participate in the data analysis, and the Cormack–Lehane (CL) grade was recorded and endotracheal intubation was completed. The relationship between DSE, DSH, DSV, HMD, and tongue width and thickness and laryngoscope exposure difficulty and tracheal intubation difficulty was analyzed. The critical value of each index for predicting laryngoscope exposure difficulty and tracheal intubation difficulty was obtained by the receiver operating characteristic curve (ROC) and Jordan index. According to the critical value, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of each index were calculated. Results. On comparing the general conditions of the four groups, this study prospectively included 220 patients undergoing elective surgery under general anesthesia for tracheal intubation in our hospital from April 2018 to April 2021, of which 8 cases were excluded from the study because of loss of incisors, 5 cases were excluded from the study due to unclear development of the anterior vocal cords under ultrasound, 7 cases were excluded from the study, and finally 200 patients were included in the study, including 104 males and 96 females. Among the 200 patients, difficult laryngoscope exposure was found in 26 cases (13.00%) and difficult tracheal intubation in 17 cases (8.50%). Tracheal intubation was performed in 17 patients with a visual laryngoscope and light rod, respectively. The weight and BMI of patients in the DL group were higher than in the NDL group, and the difference was statistically significant (
); the weight and BMI of patients in the DI group were higher than in the NDI group, and the difference was statistically significant (
); there was no significant difference in sex, age, and height between the DL group and the NDL group and the DI group and the NDI group (
). Compared with the NDL group, IID, TMD, and TMH in the DL group were lower, and the difference was statistically significant (
); there was no significant difference in ULBT (
). DSE, DSH, and DSV were higher than in the NDL group, and the difference was statistically significant (
), the HMD was lower than in the NDL group, and the difference was statistically significant (
);the width and thickness of tongue were higher than in the NDL group, and the difference was statistically significant (
). On comparing the DI NDI groups, the IID, TMD, and TMH in group DI were lower than in group NDI, and the difference was statistically significant (
), but there was no significant difference in ULBT (
); DSE, DSH, and DSV were higher than in the NDI group, and the difference was statistically significant (
); the HMD was lower than in the NDI group, and the difference was statistically significant (
); the width and thickness of tongue were higher than in the NDL group, and the difference was statistically significant (
). The AUC of BMI, TMH, DSE, DSV, HMD, and tongue width and thickness all ranged from 0.70 to 0.9. Laryngoscope exposure difficulty diagnostic value was medium. The AUC of TMD, MMT, ULBT, IID, and DSH ranged from 0.5 to 0.7. The diagnostic value of laryngoscope exposure difficulty was low. According to the ROC curve, the AUC value of HMD, DSE, and tongue thickness in ultrasonic indicators was higher than that of traditional indicators and the AUC value of TMH was the highest in traditional indicators. When the HMD cutoff value was 5.29 cm; the accuracy, sensitivity, specificity, PPV, and NPV were 73.6%, 96.7%, 71.6%, 31.8%, and 97.4%, respectively. Compared with tongue width, tongue thickness has a better predictive performance. The accuracy of DSH, DSV, DSE, and tongue width and thickness in predicting difficult laryngoscope exposure was lower than HMD and the difference was statistically significant (
). The patients in the DI and NDI groups indicated that the AUC of ULBT, TMD, and IID was between 0.5 and 0.7, the diagnostic values of BMI, MMT, TMH, DSE, DSH, DSV, HMD, and tongue width and thickness were between 0.7 and0.9, and the diagnostic value for tracheal intubation difficulty was moderate. According to the ROC curve, HMD, DSE, and tongue thickness in ultrasonic indexes were higher compared to traditional indexes. Among the traditional indexes, the AUC value of TMH is the largest. In ultrasonic indexes, when the critical value of HMD DSE is 4.85 cm, the AUC value is 0.893, and its accuracy, sensitivity, specificity, PPV, and NPV are 81.6%, 93.8%, 80.6%, 30.2%, and 99.5%, respectively. In ultrasonic indexes, the prediction performance is better, followed by the tongue thickness prediction performance. The accuracy of DSH, DSV, DSE, and tongue width and thickness in predicting difficult tracheal intubation was lower than in HMD, and the difference was statistically significant (
). Conclusion. Ultrasonic measurements such as DSH, DSE, DSV, HMD, and tongue width and thickness have predictive value for difficult airway;when the ultrasonic measurement of HMD is ˂5.29 cm, we should pay attention to the difficulty of laryngoscope exposure, and when DSE is ˂4.85 cm, we should watch out for difficult tracheal intubation. In terms of other ultrasound indexes, HMD is more valuable in predicting difficult airway.
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11
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Zhang X, Pan L, Wang L, Li LQ, Zhang P, Tang HC, Wu QG, Li F. Intervention to severe lower trachea obstruction supported by extracorporeal membrane oxygenation in a human immunodeficiency virus patient: A case report and literature review. Front Med (Lausanne) 2022; 9:965721. [PMID: 36082276 PMCID: PMC9445275 DOI: 10.3389/fmed.2022.965721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Here we reported a case, male, 33 years old, diagnosed with human immunodeficiency virus (HIV) infection 5 months ago, but he didn’t take antiretroviral drugs regularly. He was admitted to intensive care unit emergently due to hypoxemia, hypercapnia, and hypotension. CT showed severe lower trachea obstruction caused by soft tissue. After rapid bedside assessment, the patient was considered to need endotracheal operation, but he couldn‘t tolerate intubation and mechanical ventilation. Extracorporeal membrane oxygenation (ECMO) was used. Hemodynamics improved significantly along with rehydration and low-dose vasoactive drugs. Subsequently, the patient underwent rigid bronchoscopy, airway tumor resection and Y-type silicone stent implantation. Postoperatively protective endotracheal intubation and mechanical ventilation was followed. ECMO was weaned off after the operation, and endotracheal cannula was removed 6 h later. The pathological examination of excisional tissue showed lung squamous cell carcinoma. Finally, the patient was discharged safely and went to local hospital for further treatment. From this case, we conclude that ECMO could play a key role for those who need endotracheal surgery while cannot endure conventional intubation and mechanical ventilation.
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Affiliation(s)
- Xiaolin Zhang
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lei Pan
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lei Wang
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Li Q. Li
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hai C. Tang
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qing G. Wu
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- *Correspondence: Qing G. Wu,
| | - Feng Li
- Department of Respiratory Disease and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- Feng Li,
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12
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Choi SR, Eom DW, Lee TY, Jung JW, Lee GH, Lee SC, Park SY, Kim TH. Anesthetic Management of Upper Tracheal Cancer Resection and Reconstruction: A Case Report. Int Med Case Rep J 2022; 15:443-447. [PMID: 36046034 PMCID: PMC9423117 DOI: 10.2147/imcrj.s376721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022] Open
Abstract
Tracheal tumor resection and reconstruction is the primary treatment for tracheal tumors. The trachea is the surgical site as well as an important channel to ensure ventilation and maintain oxygenation during surgery. In this report, we describe the successful management of an upper tracheal tumor in a 50-year-old patient. The tumor was situated approximately 2–3 cm below the vocal cords, occluding the tracheal lumen by 80%. Conventional orotracheal intubation was expected to be impossible, and the patient was managed with an I-Gel supraglottic airway for mechanical ventilation with the assistance of venovenous extracorporeal membrane oxygenation (VV ECMO). After securing tracheal intubation via the tracheostomy site, VV ECMO was weaned off, and mechanical ventilation was changed to tracheal intubation. Eventually, tracheal tumor resection and reconstruction were successfully performed under general anesthesia. No specific events occurred during anesthetic management. Careful preoperative planning and good teamwork made the procedure possible without complications.
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Affiliation(s)
- So Ron Choi
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Deuk Won Eom
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Tae Young Lee
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Ji Wook Jung
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Gang Hyun Lee
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
- Correspondence: Sang Yoong Park, Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea, Tel +82-51-240-5390, Fax +82-51-247-7819, Email
| | - Tae Hyung Kim
- Department of Anesthesiology and Pain Medicine, University of Dong-A College of Medicine, Busan, Republic of Korea
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13
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Chen H, Yao Y, Wang S, Liu S, Yang L. Selection of the access channel in bronchoscopic intervention. Expert Rev Respir Med 2022; 16:707-712. [PMID: 35694812 DOI: 10.1080/17476348.2022.2089656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND At present, bronchoscopic intervention has become an important treatment approach for central airway obstruction (CAO). Choosing an appropriate access channel for different patients during this operation has become a research focus. METHODS Data of bronchoscopic interventions in 201 patients with CAO in which one of endotracheal intubation, laryngeal mask, or rigid bronchoscope were used as the only access channel were retrospectively reviewed. RESULTS The total immediate effective rate was 94.1% (398/423), and the main complications related to the access channels included hypoxemia, elevated arterial partial pressure of carbon dioxide, arrhythmia, airway mucosa tear, glottic edema, vocal cord injury, tooth loss, massive bleeding, airway mucosal necrosis, and asphyxia. The incidence of complications was 16.8% (71/423). Glottic edema was the most common complication with an incidence of 7.8% (33/423) and accounted for 46.5% of all complications. Glottic edema only occurred in the laryngeal mask and rigid bronchoscope groups, and the incidence was significantly correlated with the operation time (p < 0.001). Massive bleeding related to the access channel remains the most serious complication. CONCLUSIONS Endotracheal intubation, laryngeal mask, and rigid bronchoscope each have their own advantages and disadvantages. The most appropriate access channel should depend on a comprehensive assessment of the patient.
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Affiliation(s)
- Hui Chen
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Yang Yao
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Shengyu Wang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Song Liu
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Lin Yang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
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14
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Hennessy MM, Moorthy A, Frizelle H, Griffin M, Reidy B, Eaton D, Carton E. Complications of an uncovered metallic tracheal stent managed by veno-venous extracorporeal membrane oxygenation: a case report. BJA OPEN 2022; 2:100011. [PMID: 37588269 PMCID: PMC10430833 DOI: 10.1016/j.bjao.2022.100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/11/2022] [Indexed: 08/18/2023]
Abstract
Airway stents are primarily inserted for the management of airway obstruction associated with an inoperable malignancy and are rarely indicated in benign disease. We outline the complications associated with tracheal stents and describe the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) to facilitate open tracheal surgery in an apnoeic patient who had an uncovered metallic tracheal stent left in place for an inappropriately long period. Computerised tomography imaging of the neck and thorax provided information for operative planning and described of the stent in addition to the extensive granulation tissue at the distal end of the stent. Veno-venous extracorporeal membrane oxygenation was used to facilitate open tracheal surgery, removal of the tracheal stent and formation of a surgical tracheostomy. Prolonged use of an uncovered metallic airway stent in younger patients with benign disease may lead to the stent being difficult to remove. There may be an accumulation of granulation tissue with the risk of airway obstruction.
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Affiliation(s)
| | - A. Moorthy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - H. Frizelle
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. Griffin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B. Reidy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - D. Eaton
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - E. Carton
- Mater Misericordiae University Hospital, Dublin, Ireland
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15
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Edwards M, Gassman J, Rosasco J, Kim P, Pak A. A Compromised Airway in the Setting of Failed Extracorporeal Membrane Oxygenation Cannulation. Cureus 2022; 14:e25164. [PMID: 35747040 PMCID: PMC9206849 DOI: 10.7759/cureus.25164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/05/2022] Open
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16
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Barnwell N, Lenihan M. Anaesthesia for airway stenting. BJA Educ 2022; 22:160-166. [PMID: 35531077 PMCID: PMC9073313 DOI: 10.1016/j.bjae.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- N. Barnwell
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. Lenihan
- Mater Misericordiae University Hospital, Dublin, Ireland
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17
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Hung O, McAlpine J, Murphy M. Averting catastrophic outcomes: the fundamentals of "impossible" airways. Can J Anaesth 2022; 69:192-195. [PMID: 34608589 DOI: 10.1007/s12630-021-02117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Orlando Hung
- Departments of Anesthesia, Surgery, and Pharmacology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, 1276 South Park St., 10 North, Rm 275, Halifax, NS, B3H 2H8, Canada.
| | - James McAlpine
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, Canada
| | - Michael Murphy
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, Canada
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18
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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 322] [Impact Index Per Article: 161.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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19
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Weinberg AL, Graham DJ, Meyerov DJ, Moshinsky DJA, Aitken DSAA, Spanger DM, Knight DS. Tracheal stent buckling and in-stent stenosis: a case report and proposed airway management algorithm for airway obstruction for patients with tracheal stents. J Cardiothorac Vasc Anesth 2022; 36:3139-3146. [DOI: 10.1053/j.jvca.2022.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
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20
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Zhao Y, Li Z, Zhang L, Dong J, Xing C, Yao X, Li C, Wang Y, Guan Y. Extracorporeal membrane oxygenation for thyroid surgery in patients with severe tracheal stenosis. SAGE Open Med Case Rep 2022; 10:2050313X221139022. [DOI: 10.1177/2050313x221139022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Abstract
Venovenous extracorporeal membrane oxygenation is effective for maintaining gas exchange in patients with respiratory failure or severe tracheal stenosis. Perioperative anesthetic management of severe airway obstruction can be associated with ventilation or intubation difficulties. Consequently, venovenous extracorporeal membrane oxygenation could be an option for treating such patients to avoid potential risks. However, only a limited number of similar cases have been reported. Therefore, we have summarized two cases to provide theoretical and practical references for treating patients with respiratory failure or severe tracheal stenosis using extracorporeal membrane oxygenation.
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Affiliation(s)
- Yongjun Zhao
- Department of Anesthesiology, First People’s Hospital of Guangyuan, Guangyuan, China
| | - Zhe Li
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Anesthesiology, First People’s Hospital of Guangyuan, Guangyuan, China
| | - Jianjun Dong
- Department of Intensive Care Medicine, First People’s Hospital of Guangyuan, Guangyuan, China
| | - Chaoyang Xing
- Department of Intensive Care Medicine, First People’s Hospital of Guangyuan, Guangyuan, China
| | - Xingzhu Yao
- Department of Anesthesiology, First People’s Hospital of Guangyuan, Guangyuan, China
| | - Chunshan Li
- Department of Hepatobiliary surgery, First People’s Hospital of Guangyuan, Guangyuan, China
| | - Yi Wang
- Department of Anesthesiology, First People’s Hospital of Guangyuan, Guangyuan, China
| | - Yulong Guan
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Ni Fhlatharta M, Khan A, Carton E, Redmond KC. Pre-emptive extracorporeal membrane oxygenation to support endobronchial stenting for severe airway obstruction. Eur J Cardiothorac Surg 2021; 59:1345-1346. [PMID: 33225355 DOI: 10.1093/ejcts/ezaa425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/10/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022] Open
Abstract
Tracheobronchial stent insertion is a common palliative intervention for the management of dynamic airway collapse due to severe tracheobronchomalacia or tracheal compression due to mass effect [1]. Airway stents are usually placed bronchoscopically with or without fluoroscopy. In more complex cases, airway stents are placed using a rigid bronchoscope under general anaesthesia with conventional or jet ventilation. In patients where advancement of a rigid bronchoscope into the distal airway or ventilation through a rigid bronchoscope may be difficult, pre-emptive awake veno-venous extracorporeal membrane oxygenation should be considered. This report is the first publication to describe a novel technique in a series of patients being treated for critical airway obstruction who would otherwise be at risk of respiratory arrest at the induction of anaesthesia.
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Affiliation(s)
- Meadhbh Ni Fhlatharta
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Asad Khan
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edmund Carton
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Karen C Redmond
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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22
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Liang Y, Zhu J, Zheng X, Qiao Q, Guan Y, Zhang J, Chen E. Application of extracorporeal membrane oxygenation in the endoscopic treatment of severe benign airway stenosis: A case report and literature review. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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23
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Sun X, Chen C, Zhou R, Chen G, Jiang C, Zhu T. Anesthesia and airway management in a patient with acromegaly and tracheal compression caused by a giant retrosternal goiter: a case report. J Int Med Res 2021; 49:300060521999541. [PMID: 33878943 PMCID: PMC8074480 DOI: 10.1177/0300060521999541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A giant retrosternal goiter can lead to compression of vital organs in the mediastinum with high risk of acute cardiorespiratory decompensation. Additionally, patients with acromegaly are prone to developing severe airway obstruction and ventilation difficulties during anesthetic induction, leading to hypoxia and an increased partial pressure of carbon dioxide. Therefore, more comprehensive airway management strategies are needed. We herein describe a 57-year-old man with acromegaly and severe tracheal obstruction caused by a giant retrosternal goiter. He presented with a 1-week history of progressive dyspnea and was scheduled to undergo right lobe thyroidectomy and retrosternal goiter thyroidectomy. We created a comprehensive emergency plan for a difficult airway, including regional and topical anesthesia for awake endotracheal intubation, sevoflurane inhalation, small doses of midazolam and sufentanil to increase tolerance, self-made extended-length tracheostomy, video laryngoscope-assisted fiber-optic bronchoscopy, extracorporeal membrane oxygenation, and surgical tracheostomy. Importantly, tetracaine was inhaled through an atomizer, and a laryngotracheal topical anesthesia applicator was used to spray the larynx with 1% tetracaine to reduce stimulation during intubation. The giant goiter was successfully removed through the cervical approach. A carefully designed airway management strategy and close communication among a multidisciplinary operation team are the basis of perioperative anesthetic management for these patients.
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Affiliation(s)
- Xiaohui Sun
- Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruihao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunling Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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24
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Bronchotracheal Stenting Management by Rigid Bronchoscopy under Extracorporeal Membrane Oxygenation (ECMO) Support: 10 Years of Experience in a Tertiary Center. Can Respir J 2021; 2021:8822591. [PMID: 33791047 PMCID: PMC7997761 DOI: 10.1155/2021/8822591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Airway stenting offers good palliation and improves the quality of life in patients with inoperable bronchotracheal stenosis. However, in some cases, the management of stenting can be life-threatening. Hence, a strategy for maintaining oxygenation and hemodynamic stability should be anticipated to avoid critical situations. Herein, we report the use of extracorporeal membrane oxygenation (ECMO) in bronchotracheal stenting management to secure oxygenation and facilitate interventions. Methods We retrospectively reviewed all patients who underwent rigid bronchoscopy under ECMO support for the management of bronchotracheal stenting at CHU UCL Namur hospital (Belgium), between January 2009 and December 2019. Results We included 14 bronchoscopy cases performed on 11 patients (3 patients underwent 2 bronchoscopies) in this study; 12 were performed on males and 2 on females. The median age was 54 years. There were 11 benign and 3 malignant etiologies for the central airway obstruction/stenosis. Eight cases were supported by venovenous ECMO and six by venoarterial ECMO. The median ECMO time was 267 minutes. The weaning of ECMO support was successful in all cases. In most cases, the procedures were performed effectively and safely. Only two local complications caused by the cannulation of ECMO were reported, and anticoagulation was adapted to avoid bleeding at the operating site and clot formation in the system. Conclusion Elective ECMO support was helpful and safe for the high-risk management of bronchotracheal stenting with rigid bronchoscopy and was not associated with any additional significant complications.
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25
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Khanna S, Ong T, Chow C, Trombetta C. Giant pulmonary artery aneurysms. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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26
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Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth 2021; 68:1405-1436. [PMID: 34105065 PMCID: PMC8186352 DOI: 10.1007/s12630-021-02008-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. SOURCE Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. FINDINGS AND KEY RECOMMENDATIONS Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient's tolerance for withdrawal of airway support and whether re-intubation might be difficult.
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Misra S, Behera BK, Preetam C, Mohanty S, Mahapatra RP, Tapuria P, Elayat A, Nayak A, Kotkar K, McNeil JS, Blank RS. Peripheral Cardiopulmonary Bypass in Two Patients With Symptomatic Tracheal Masses: Perioperative Challenges. J Cardiothorac Vasc Anesth 2020; 35:1524-1533. [PMID: 33339662 DOI: 10.1053/j.jvca.2020.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022]
Abstract
Tracheal tumors or masses causing critical airway obstruction require resection for symptom relief. However, the location and extent of these tumors or masses often preclude conventional general anesthesia and tracheal intubation. Peripheral cardiopulmonary bypass often is required before anesthetizing these patients. Herein, two cases of patients with tracheal masses, in whom awake peripheral cardiopulmonary bypass was instituted, are reported. The first case was that of an obese male child weighing 102 kg, with tracheal rhinoscleroma, who developed Harlequin, or north-south, syndrome after institution of femorofemoral venoarterial partial cardiopulmonary bypass. The second case was that of a female patient with adenoid cystic carcinoma of the trachea causing near-total central airway occlusion. She had severe pulmonary artery hypertension, which prevented the use of venovenous bypass. Instead, femoral vein-axillary artery venoarterial bypass was established to avoid Harlequin syndrome. Some of the challenges encountered were the development of Harlequin syndrome with risk of myocardial and cerebral ischemia, type and conduct of extracorporeal bypass, choice of monitoring sites, and provision of regional anesthesia for peripheral extracorporeal cannulations. Management of such patients needs frequent troubleshooting and multidisciplinary coordination for a successful surgical outcome.
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Affiliation(s)
- Satyajeet Misra
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
| | - Bikram Kishore Behera
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Chappity Preetam
- Department of ENT, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Satyapriya Mohanty
- Department of Cardiac Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Rudra Pratap Mahapatra
- Department of Cardiac Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Priyank Tapuria
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Anirudh Elayat
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Anindya Nayak
- Department of ENT, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Kunal Kotkar
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - John S McNeil
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Randal S Blank
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
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28
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Kodia K, Liu Y, Ghodsizad A, Turner D, Briski L, Nguyen DM. Use of venovenous extracorporeal membrane oxygenation for resection of a large paratracheal mass causing critical tracheal stenosis: A case report. J Card Surg 2020; 36:367-370. [PMID: 33225496 DOI: 10.1111/jocs.15207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/17/2022]
Abstract
Critical airway stenosis is challenging for surgeons and anesthesiologists to secure a reliable airway for ventilation. The use of venovenous (VV)-extracorporeal membrane oxygenation (ECMO) has been described as a strategy to provide adequate gas exchange in such instances. We present a case of a young female with a complex paratracheal mass significantly compressing the trachea; a planned intraoperative VV-ECMO was instituted to allow safe orotracheal intubation of a double-lumen endotracheal tube for lung isolation and tumor resection.
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Affiliation(s)
- Karishma Kodia
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Yuda Liu
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Ali Ghodsizad
- Division of Cardiothoracic Transplantation, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, Florida, USA
| | - Darren Turner
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
| | - Laurence Briski
- Department of Pathology, University of Miami, Miami, Florida, USA
| | - Dao M Nguyen
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Miami, Miami, Florida, USA
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Abstract
In this report, we present a case of a patient with a history of complex airway anatomy secondary to Sagliker syndrome (SS) who presented with acute exacerbation of chronic respiratory failure. The patient's difficult airway, complicated medical comorbidities, and poor psychosocial status posed a unique challenge for providing safe care during an emergency. The perioperative anesthesia service (PAS), led by critical care anesthesiologists, coordinated a multidisciplinary airway management plan. The PAS team also assisted this medically complex patient with her decision-making process. A 37-year-old female with SS, which is characterized by irreversible disfiguring of head and neck anatomy secondary to end-stage renal disease (ESRD) and poorly controlled hyperparathyroidism, presented with acute exacerbation of chronic respiratory failure due to hypervolemia. The patient's respiratory status rapidly deteriorated despite aggressive hemodialysis, requiring transfer to the ICU. Given the challenging anatomy and poor respiratory reserve in this patient, the PAS team helped coordinate a comprehensive airway plan that involved transnasal fiberoptic intubation, and in case of emergency, extracorporeal membrane oxygenation (ECMO) as a bridge to a surgical airway. During the decision-making process, the patient was found to be in psychological distress and had limited insights into her condition. The PAS team helped facilitated multidisciplinary goals-of-care discussions for the patient and her family. Fortunately, the patient's oxygenation improved with noninvasive oxygen support and aggressive hemodialysis without the need for intubation. She was discharged with outpatient follow-up appointments arranged to discuss long-term management. This is the first reported case of SS in the United States. The early involvement by the PAS team helped coordinate a multidisciplinary care plan for this patient with a difficult airway and complex comorbidities. This report highlights an innovative airway algorithm for a potentially "cannot-intubate, cannot ventilate" complex airway, and the PAS team's role in providing support for the patient's physical and psychological needs, suggesting that a comprehensive perioperative service can improve the quality and safety of care, not only for surgical patients but also for medically complex patients as well.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Stanford University, Stanford, USA
| | - Javier Lorenzo
- Department of Anesthesiology, Stanford University, Stanford, USA
| | - Amy Lu
- Department of Anesthesiology, Stanford University, Stanford, USA
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Rivera-Tocancipá D. Pediatric airway: What is new in approaches and treatments? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Perioperative morbidity and mortality are high among patients in the extremes of life undergoing anesthesia. Complications in children occur mainly as a result of airway management-related events such as difficult approach, laryngospasm, bronchospasm and severe hypoxemia, which may result in cardiac arrest, neurological deficit or death. Reports and new considerations that have changed clinical practice in pediatric airway management have emerged in recent years. This narrative literature review seeks to summarize and detail the findings on the primary cause of morbidity and mortality in pediatric anesthesia and to highlight those things that anesthetists need to be aware of, according to the scientific reports that have been changing practice in pediatric anesthesia.
This review focuses on the identification of “new” and specific practices that have emerged over the past 10 years and have helped reduce complications associated with pediatric airway management. At least 9 practices grouped into 4 groups are described: assessment, approach techniques, devices, and algorithms. The same devices used in adults are essentially all available for the management of the pediatric airway, and anesthesia-related morbidity and mortality can be reduced through improved quality of care in pediatrics.
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Cohen W, Mirzai S, Combs P, Rose R, Kagan V, Correia C, Gottlieb LJ, Song T. Postoperative extracorporeal membrane oxygenation can successfully support patients following upper airway reconstruction. Head Neck 2020; 42:E30-E34. [PMID: 32767409 DOI: 10.1002/hed.26371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients requiring intensive upper airway reconstruction are anatomically restricted in terms of the respiratory support they can receive. While intraoperative extracorporeal membrane oxygenation (ECMO) has been effectively utilized, little has been shown regarding the utility of ECMO for long-term support in these patients. METHODS We demonstrate how a patient with tongue and hypopharyngeal squamous cell carcinoma that necessitated upper airway reconstruction was supported with veno-venous (VV) ECMO due to postoperative respiratory failure and an inability to maintain a stable airway. RESULTS By initiating VV ECMO, we were able to decrease positive pressure ventilation and FiO2 , thereby minimizing ventilator-associated trauma and irritation to facilitate wound healing. Over time, ventilatory support was increased in parallel with decreasing ECMO support, allowing discharge to rehabilitation after 74 days of ECMO. CONCLUSION ECMO can effectively support patients with ongoing respiratory requirements following upper airway reconstruction when standard ventilatory techniques are inadequate or not feasible.
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Affiliation(s)
- William Cohen
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Saeid Mirzai
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Pamela Combs
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Rebecca Rose
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Viktoriya Kagan
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Camil Correia
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Lawrence J Gottlieb
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Tae Song
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Essig GF, Niermeyer WL, Essandoh M, Dewhirst E, Gerlach RM, Gonzalez LS, Chaney MA. Averting Risk of Airway Loss During Surgical Management of Retrosternal Goiters. J Cardiothorac Vasc Anesth 2020; 34:2260-2268. [DOI: 10.1053/j.jvca.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/17/2022]
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Kakizaki R, Bunya N, Uemura S, Narimatsu E. Successful difficult airway management with emergent venovenous extracorporeal membrane oxygenation in a patient with severe tracheal deformity: a case report. Acute Med Surg 2020; 7:e539. [PMID: 32724660 PMCID: PMC7377931 DOI: 10.1002/ams2.539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Difficult airway management is occasionally encountered in the emergency department, and recent studies suggest that extracorporeal membrane oxygenation can be useful in these cases. Case Presentation A 74-year-old man was transferred to our hospital due to worsening dyspnea. On arrival, it was found that he was in respiratory distress and was comatose. Arterial blood gas analysis showed severe hypercapnia and respiratory acidosis. Intubation could not be done because he had severe tracheal deformity due to cervical-thoracic kyphosis secondary to vertebral tuberculosis. Therefore, we carried out surgical tracheostomy under venovenous extracorporeal membrane oxygenation. The patient's oxygenation gradually improved, and extracorporeal membrane oxygenation was withdrawn on day 8. He was transferred to another hospital on day 46 and suffered no neurological deficits. Conclusion Severe tracheal deformity can result in a difficult airway. Extracorporeal membrane oxygenation is an effective life-saving approach in cases of difficult airway management due to severe tracheal deformity.
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Affiliation(s)
- Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
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Chen Z, Lv Y, Feng Y. Case Report of Acute Airway Obstruction Caused by Transglottic Squamous Carcinoma (Stage IV) During the Coronavirus Pandemic Cured by ECMO-Assisted Tracheostomy. EAR, NOSE & THROAT JOURNAL 2020; 100:113S-115S. [PMID: 32687410 DOI: 10.1177/0145561320943354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Acute airway obstruction caused by invasive laryngeal cancer can make surgeons reluctant to perform a high-risk tracheostomy, which is life-saving for such patients. In the setting of the current COVID19 pandemic, we present a case of severe transglottic stenosis due to stage IV laryngeal carcinoma, in which gaseous exchange was facilitated by venovenous (VV) extracorporeal membrane oxygenation prior to emergent tracheostomy. The VV technique can ensure adequate oxygenation and CO2 removal. Venovenous extracorporeal membrane oxygenation provided sufficient time for surgical planning and preparation. It reduced the formation of aerosol, lowered the risk associated with life-saving tracheostomy, and protected the patient from ischemia.
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Affiliation(s)
- Zhongyan Chen
- Department of Otolaryngology, 36635China-Japan Friendship Hospital, Beijing, China
| | - Yong Lv
- Department of Otolaryngology, 36635China-Japan Friendship Hospital, Beijing, China
| | - Yun Feng
- Department of Otolaryngology, 36635China-Japan Friendship Hospital, Beijing, China
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Chakalov I, Harnisch L, Meyer A, Moerer O. Preemptive veno-venous ECMO support in a patient with anticipated difficult airway: A case report. Respir Med Case Rep 2020; 30:101130. [PMID: 32596130 PMCID: PMC7306610 DOI: 10.1016/j.rmcr.2020.101130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
This report presents a case of endotracheal metastasis in which elective veno-venous extracorporeal membrane oxygenation (VV ECMO) was used to undergo tracheal laser-surgery prior to establishment of a definitive airway. Specifically, we describe the respiratory and airway management in an adult patient from the preclinical phase throughout elective preoperative ECMO implantation to postoperative ECMO weaning and decannulation in the Intensive Care Unit. This case report lends further supports to the idea that the extracorporeal membrane oxygenation could be electively used to provide safe environment for surgery in situations where the standard maneuvers of sustaining adequate gas exchange are anticipated to fail.
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Affiliation(s)
- I. Chakalov
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany Robert-Koch-Str. 40, D-37099, Göttingen, Germany
| | - L.O. Harnisch
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany Robert-Koch-Str. 40, D-37099, Göttingen, Germany
| | - A.C. Meyer
- Department of Ear-, Nose-, and Throat Surgery, University Medical Center Göttingen, Göttingen, Germany Robert-Koch-Str. 40, D-37099, Göttingen, Germany
| | - O. Moerer
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany Robert-Koch-Str. 40, D-37099, Göttingen, Germany
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A multidisciplinary approach for managing the infraglottic difficult airway in the setting of the Coronavirus pandemic. ACTA ACUST UNITED AC 2020; 31:128-137. [PMID: 32572325 PMCID: PMC7260599 DOI: 10.1016/j.otot.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of a difficult airway caused by pathology below the glottis is high-risk and requires a shared approach to airway planning and surgical treatment. Access to the trachea requires a careful assessment of the airway since the end-point of laryngoscopy for infraglottic airway management is not visualization of the larynx for tube placement, but access to the laryngotracheal complex in cases where intubation may not be feasible or may preclude surgical access. This work provides a common framework for creating multidisciplinary shared-airway management plans and presents devices and strategies that have in recent years improved airway management safety in this difficult patient group and may prove useful in the setting of the novel Coronavirus Disease 2019 (COVID-19).
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Pu H, Lei Y, Yuan D, Zhou Y. Tracheal Reconstruction Surgery Supported by Extracorporeal Membrane Oxygenation for Patients with Traumatic Post-Tracheotomy Tracheal Stenosis. Ann Thorac Cardiovasc Surg 2020; 26:327-331. [PMID: 32475889 PMCID: PMC7801178 DOI: 10.5761/atcs.oa.20-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSES Patients who require surgeries for traumatic post-tracheotomy tracheal stenosis (PTTS) often cannot be supported using conventional airway management approaches. This study documents the use of extracorporeal membrane oxygenation (ECMO) in patients with PTTS. METHODS Patient characteristics, procedure, and outcome of patients who required tracheal reconstruction surgery for PTTS supported by ECMO were retrieved and analyzed. RESULTS Four patients (mean age 28 years; range 17-48 years) with traumatic PTTS underwent tracheal reconstruction surgery supported by ECMO. The mean time from removal of tracheotomy tube to admission was 3.2 months (range: 1-9 months). The mean diameter of the stenotic segment was 5 mm (range: 4-6 mm). One patient underwent tracheoplasty and semi-tracheostomy with venoarterial ECMO urgently. Three patients underwent tracheal resection and end-to-end anastomosis (TRE) with venovenous ECMO empirically. Intervention success was achieved in 100% (4/4) of patients. The mean duration of ECMO was 35.3 hours (range: 16-53 hours). The overall survival rate was 100% (4/4) within a mean follow-up of 26 months (range: 7-57 months). CONCLUSIONS ECMO is a safe and feasible method to support oxygenation for patients with critical traumatic PTTS during tracheal reconstruction surgery.
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Affiliation(s)
- Hong Pu
- Department of Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yu Lei
- Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Dongqiong Yuan
- Department of Critical Care Medicine, Chengdu Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan Zhou
- Department of Critical Care Medicine, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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Odigwe C, Krieg J, Owens W, Lopez C, Arya RR. Usefulness of extracorporeal membrane oxygenation in status asthmaticus with severe tracheal stenosis. Proc (Bayl Univ Med Cent) 2020; 33:404-406. [PMID: 32675965 DOI: 10.1080/08998280.2020.1759333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
Extracorporeal membrane oxygenation, traditionally used to treat refractory hypoxemic respiratory failure due to acute respiratory distress syndrome, is being used to treat other etiologies of severe respiratory failure refractory to conventional mechanical ventilation. We present a 30-year-old woman with concomitant life-threatening airway obstruction due to severe tracheal stenosis and status asthmaticus treated effectively with veno-venous extracorporeal membrane oxygenation.
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Affiliation(s)
- Chibuzo Odigwe
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - Jake Krieg
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - William Owens
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - Cathy Lopez
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - Rohan Ranjit Arya
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
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Louis M, Graham J, Spanger M, Ho A, Lee DK, Barnett S, Weinberg L. Life-Threatening Laryngeal Emphysema After Video-Assisted Thoracoscopic Surgery. J Cardiothorac Vasc Anesth 2020; 34:2460-2464. [PMID: 32144069 DOI: 10.1053/j.jvca.2020.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Maleck Louis
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Jonathan Graham
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Manfred Spanger
- Department of Radiology, Box Hill Hospital, Box Hill, Australia
| | - Alexander Ho
- Department of Anesthesia, Austin Health, Heidelberg, Australia; Department of Thoracic Surgery, Austin Health, Heidelberg, Australia
| | - Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Stephen Barnett
- Department of Thoracic Surgery, Austin Health, Heidelberg, Australia
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40
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Karim AS, Son AY, Suen R, Walter JM, Saine M, Kim SS, Odell DD, Thakkar S, Kurihara C, Bharat A. Pre-Intubation Veno-Venous Extracorporeal Membrane Oxygenation in Patients at Risk for Respiratory Decompensation. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:52-57. [PMID: 32280144 PMCID: PMC7138124 DOI: 10.1182/ject-1900035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a potential life-saving treatment for patients with acute respiratory failure. Given the accumulating literature supporting the use of VV-ECMO without therapeutic levels of anticoagulation, it might be feasible to use it for planned intubation before surgical procedures. Here, we report consecutive series of patients who underwent planned initiation of VV-ECMO, without anticoagulation, before induction of general anesthesia for anticipated difficult airways or respiratory decompensation. We describe the approach to safely initiate VV-ECMO in an awake patient. We retrospectively identified patients in a prospectively maintained database who underwent planned initiation of VV-ECMO before intubation. Standard statistical methods were used to determine post-procedure outcomes. Patients included were three men and one woman, with a mean age of 34.3 ± 10.4 years. Indications included mediastinal lymphoma, foreign body obstruction, hemoptysis, and tracheo-esophageal fistula. VV-ECMO was initiated electively for all patients, and no anticoagulation was used. The median duration of VV-ECMO support was 2.5 days (1-11 days), the median length of ventilator dependence and intensive care unit stay was 1 day (1-23 days) and 5 days (4-31 days), respectively. The median length of stay was 18.5 days (8-39 days). There were no thrombotic complications and no mortality at 30 days. Initiation of awake VV-ECMO is feasible and is safe before intubation and induction of anesthesia in patients at high risk for respiratory decompensation.
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Affiliation(s)
- Azad S Karim
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andre Y Son
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rachel Suen
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James M Walter
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Saine
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel S Kim
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David D Odell
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanket Thakkar
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chitaru Kurihara
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Zuo M, Huang Y, Ma W, Xue Z, Zhang J, Gong Y, Che L. Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019. CHINESE MEDICAL SCIENCES JOURNAL = CHUNG-KUO I HSUEH K'O HSUEH TSA CHIH 2020; 35:3724. [PMID: 32102726 PMCID: PMC7367670 DOI: 10.24920/003724] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/18/2022]
Abstract
Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China and spread to multiple countries through infected persons travelling by air. Most of the infected patients have mild symptoms including fever, fatigue and cough. But in severe cases, patients can progress rapidly and develop to the acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human-to-human. Therefore, high-risk aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne PPE should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made.
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Affiliation(s)
- Mingzhang Zuo
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Wuhua Ma
- Department of Anesthesiology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhanggang Xue
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Jiaqiang Zhang
- Department of Anesthesiology, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Yahong Gong
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Lu Che
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Affiliation(s)
| | - David W Healy
- University of Michigan Medical School, Ann Arbor, MI
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Nagasaka A, Shimizu T, Minami T, Takenaka I. Anticipated difficult airway management using a model of the upper airway. Can J Anaesth 2020; 67:1078-1080. [PMID: 32034675 DOI: 10.1007/s12630-020-01590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
- Aiko Nagasaka
- Department of Anesthesiology, University of Occupational Environmental Health Japan, Yahatanishi, Kitakyushu, Japan.
| | - Takehiro Shimizu
- Department of Anesthesiology, Wakamatsu Hospital of the University of Occupational Environmental Health Japan, Wakamatsu, Kitakyushu, Japan
| | - Tomoko Minami
- Department of Anesthesia, Kyushu Rosai Hospital, Kokuraminami, Kitakyushu, Japan
| | - Ichiro Takenaka
- Department of Anesthesia, Kyushu Rosai Hospital, Kokuraminami, Kitakyushu, Japan
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Acute Awake Fiberoptic Intubation in the ICU in a Patient with Limited Mouth Opening and Hypoxemic Acute Respiratory Failure. Case Rep Anesthesiol 2019; 2019:6421910. [PMID: 31772778 PMCID: PMC6854940 DOI: 10.1155/2019/6421910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022] Open
Abstract
The incidence and survival of patients with head-and-neck cancer have been on the increase for decades. Following surgery or radiation therapy, complications such as difficult airways may evolve. These difficult airways may be unique and not manageable with conventional intubation methods as well as video laryngoscopes. Acute awake fiberoptic intubation may be a feasible option also for urgent emergency airway management of known difficult airways. The “cannot intubate–cannot oxygenate” (CI–CO) situation has to be avoided at all costs, since emergency cricothyrotomy has a fail ratio of more than 50% when performed by an anesthesiologist.
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Jeong YI, Jun IG, Ha SS, Kwon HJ, Lee YM. Extracorporeal membrane oxygenation for the anesthetic management of a patient with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms: A case report. Medicine (Baltimore) 2019; 98:e17650. [PMID: 31626151 PMCID: PMC6824649 DOI: 10.1097/md.0000000000017650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy. DIAGNOSIS Preoperative computed tomography showed a large goiter extending into the thoracic cavity, with diffuse segmental tracheal narrowing for 6 cm. The diameter at the narrowest portion of the trachea was 4.29 mm. INTERVENTIONS Before the induction of general anesthesia, we applied extracorporeal membrane oxygenation (ECMO) in preparation for potential difficulties in securing the airway during general anesthesia. Subsequently, anesthesia was successfully induced and maintained. OUTCOMES After the surgical procedure, fiberoptic bronchoscopy and chest radiography showed resolution of the tracheal narrowing. ECMO was weaned 2 hours after the surgery, and the patient was extubated on the first postoperative day. He was discharged without any complication. CONCLUSION The findings from this case suggest that the use of ECMO before the induction of general anesthesia is a safe method for maintaining oxygenation in patients with severe tracheal obstruction.
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Chen R. Concern regarding the use of extracorporeal membrane oxygenation in the anticipated difficult airway. Can J Anaesth 2019; 66:1115-1116. [DOI: 10.1007/s12630-019-01416-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
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Hung O, Malpas GA, Wong C. In reply: Concern regarding the use of extracorporeal membrane oxygenation in the anticipated difficult airway. Can J Anaesth 2019; 66:1117-1118. [PMID: 31172364 DOI: 10.1007/s12630-019-01417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/14/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Orlando Hung
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Gemma A Malpas
- Department of Adult and Emergency Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Chrison Wong
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Phipps SJ, Meisner JG, Watton DE, Malpas GA, Hung OR. The Role of ECMO in the "At-Risk" Tracheal Extubation: A Case Report. A A Pract 2019; 12:41-43. [PMID: 30020103 DOI: 10.1213/xaa.0000000000000838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tracheal extubation requires careful planning and preparation. We present the extubation of a patient with severe ankylosing spondylitis after cervical spine surgery. We discuss the use of extracorporeal membrane oxygenation (ECMO) in this "at-risk" extubation, where our ability to oxygenate was uncertain and reintubation was predicted to be difficult. To our knowledge, ECMO has not previously been used in this context. We suggest preparing ECMO for rescue oxygenation when all other fundamental oxygenation techniques are predicted to be difficult or impossible. ECMO could be included in airway management and extubation guidelines.
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Affiliation(s)
| | | | | | | | - Orlando R Hung
- Anesthesiology, Surgery, and Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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Booka E, Kitano M, Nakano Y, Mihara K, Nishiya S, Nishiyama R, Shibutani S, Egawa T, Nagashima A. Life-threatening giant esophageal neurofibroma with severe tracheal stenosis: a case report. Surg Case Rep 2018; 4:107. [PMID: 30178113 PMCID: PMC6120858 DOI: 10.1186/s40792-018-0517-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Benign esophageal tumors are relatively rare, and a neurofibroma in the esophagus is extremely rare. Dysphagia is the most common clinical manifestation in patients with esophageal neurofibroma, and no cases of giant esophageal neurofibroma with severe tracheal stenosis have been reported. CASE PRESENTATION A 73-year-old woman presented with shortness of breath, and computed tomography scan exhibited a giant mediastinal tumor causing severe tracheal stenosis. An upper gastrointestinal endoscopy revealed a giant submucosal lesion without mucosal changes located 18-23 cm from the incisor teeth. 18F-fluorodeoxyglucose (FDG)-positron emission tomography image revealed an upper mediastinal homogeneous mass and left supraclavicular lymph node with increased FDG accumulation. We performed endoscopic ultrasound-guided fine-needle aspiration biopsy; however, a definitive diagnosis could not be determined. During further investigation, her shortness of breath suddenly worsened and she suffered from wheezing. Because of risk of smothering, we decided to perform quasi-urgent lifesaving surgery. Under the preparation of extracorporeal membrane oxygenation (ECMO) when tracheal intubation fails, bronchial blocker was inserted over the tracheal stenosis and the left-lung ventilation was performed via intubation alone. Under general anesthesia, the patient was placed in the left lateral position and we performed right thoracotomy. The tumor strongly adhered to the trachea; however, the trachea or recurrent laryngeal nerves were not damaged in the surgery. Following esophagectomy, we performed gastric conduit reconstruction through the posterior mediastinum, and hand-sewn anastomosis was performed in the left neck. Immunohistochemical staining was positive for S-100 but negative for c-KIT, CD34, α-SMA, and desmin; these morphological and immunohistochemical characteristics were consistent with the diagnosis of neurofibroma. CONCLUSIONS It is often difficult to diagnose esophageal neurofibroma preoperatively. The preparation of ECMO could be considered in patients with severe airway obstruction for safe tracheal intubation. This is the first case of life-threatening giant esophageal neurofibroma with severe tracheal stenosis.
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Affiliation(s)
- Eisuke Booka
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan.
| | - Mitsuhide Kitano
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Yutaka Nakano
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Koki Mihara
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Shin Nishiya
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Ryo Nishiyama
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Shintaro Shibutani
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Tomohisa Egawa
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan
| | - Atsushi Nagashima
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-0012, Japan.,Department of Surgery, Saiseikai Kanagawaken Hospital, 6-6 Tomiya-cho, Kanagawa-ku, Yokohama, Kanagawa, 221-8601, Japan
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