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Okamoto S, Somiya N, Hotta R, Saka H, Oki M, Tomita A. Risk Factors for Desaturation in Anesthetic Management During Airway Stenting. Kurume Med J 2024; 69:135-142. [PMID: 38233186 DOI: 10.2739/kurumemedj.ms6934003] [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] [Indexed: 01/19/2024]
Abstract
Airway stenting involves a stent being inserted into a stenotic site in the airway. In patients with airway stenosis, the airway is the surgical field; therefore, anesthetic management is challenging, and avoiding hypoxia is important. Limited information is available on the anesthetic management of airway stenting. Risk factors for oxygen desaturation during airway stenting remain unknown. The present study was conducted to retrospectively examine patients who underwent airway stenting during a specific period and identify risk factors associated with oxygen desaturation. We performed univariate and multivariate analyses. The main evaluation items in a multivariate analysis were risk factors for desaturation (SpO2 ≤ 90%). Body mass index, preoperative orthopnea, the stenotic site of the airway, and severity of stenosis were selected for clinical usefulness. We analyzed 302 patients who underwent airway stenting at our hospital between July 2011 and June 2014 under general anesthesia with controlled ventilation. Total intravenous anesthesia with propofol target-controlled infusion and remifentanil was performed. Clinical data were extracted from electronic anesthetic records. The incidence of desaturation (SpO2 ≤ 90%) was 18.5% (56 out of 302 cases). Preoperative orthopnea (OR, 3.06)and stenosis distal to the bronchus (OR, 3.31) were identified as risk factors for desaturation in a multivariate analysis. We herein identified risk factors for desaturation during airway stenting. Anesthetic plans need to be carefully considered for patients with these risk factors.
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Affiliation(s)
- Sakura Okamoto
- Department of Anesthesiology, National Hospital Organization Nagoya Medical Center
| | - Namie Somiya
- Department of Anesthesiology, National Hospital Organization Nagoya Medical Center
| | - Ran Hotta
- Department of Anesthesiology, National Hospital Organization Nagoya Medical Center
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center
| | - Akira Tomita
- Department of Anesthesiology, National Hospital Organization Nagoya Medical Center
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2
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Liang L, Su S, He Y, Peng Y, Xu S, Liu Y, Zhou Y, Yu H. Early extracorporeal membrane oxygenation as bridge for central airway obstruction patients caused by neck and chest tumors to emergency surgery. Sci Rep 2023; 13:3749. [PMID: 36878956 PMCID: PMC9988871 DOI: 10.1038/s41598-023-30665-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Central airway obstruction caused by neck and chest tumors is a very dangerous oncological emergency with high mortality. Unfortunately, there is few literature to discuss an effective way for this life-threating condition. Providing effective airway managements, adequate ventilation and emergency surgical interventions are very important. However, traditional airway managements and respiratory support has only limited effect. In our center, using extracorporeal membrane oxygenation (ECMO) as a novel approach to manage patient with central airway obstruction caused by neck and chest tumors has been adopted. We aimed to show the feasibility: using early ECMO to manage difficult airway, provide oxygenation and support surgical procedure for patients with critical airway stenosis caused by neck and chest tumors. We designed a single-center, small sample size retrospective study based on real-world. We identified 3 patients with central airway obstruction caused by neck and chest tumors. ECMO was used to ensure adequate ventilation to emergency surgery. Control group cannot be established. Because traditional manner very likely led to death of such patients. Details of clinical characteristics, ECMO, surgery and survival outcomes were recorded. Acute dyspnea and cyanosis were the most frequent symptoms. All patients (3/3) showed descending arterial partial pressure of oxygen (PaO2). Computed tomography (CT) revealed severe central airway obstruction caused by neck and chest tumors in all cases (3/3). All patients (3/3) had definite difficult airway. All cases (3/3) received ECMO support and emergency surgical procedure. Venovenous ECMO was the common mode for all cases. 3 patients weaned off ECMO successfully without any ECMO-related complications. Mean duration of ECMO was 3 h (range: 1.5-4.5 h). Under ECMO support, difficult airway management and emergency surgical procedure were finished successfully for all cases (3/3). The mean ICU stay was 3.3 days (range: 1-7 days), and the mean general ward stay was 3.3 days (range: 2-4 days). Pathology demonstrated the tumor dignity for 3 patients including 2 malignant cases and 1 benign case. All patients (3/3) were discharged from hospital successfully. We showed that early ECMO initiation was a safe and feasible approach to manage difficult airway for patients with severe central airway obstruction caused by neck and chest tumors. Meanwhile, early ECMO initiation could ensure security for airway surgical procedure.
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Affiliation(s)
- LianJing Liang
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - ShiTong Su
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China.,Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - YaRong He
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - YaLan Peng
- Medical General Department of Medical Affairs Division, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - ShuYun Xu
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yang Liu
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - YaXiong Zhou
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - HaiFang Yu
- Emergency Medicine Department, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, 610041, China.
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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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Yamada Y, Ohata T, Kitahara M, Kohata H, Kumasawa J, Kohno M. Venovenous extracorporeal membrane oxygenation for the management of critical airway stenosis. J Artif Organs 2018; 21:479-481. [PMID: 30291469 DOI: 10.1007/s10047-018-1070-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022]
Abstract
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used not only support gas transfer of patients suffering from respiratory failure, but also to manage hypoxic patients with critical airway obstruction during various procedures. We present a case in which we electively used VV-ECMO to facilitate tube placement and tracheal biopsy in a 67-year-old female with critical tracheal stenosis. The patient was transferred to our hospital for a surgical treatment after emergent tracheostomy for postoperative management of cerebral hemorrhage in right putamen. Her trachea was severely stenotic and just enough for a 5.5 mm tracheostomy tube. Removal of tracheostomy tube, tracheal wall biopsy and intra-tracheal tube placement were successfully performed under VV-ECMO support, drainage from inferior vena cava returned into the right ventricle (RV). RV perfusion was a very useful and effective method in VV-ECMO system, although some careful wire management was needed under fluoroscopic guidance.
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Affiliation(s)
- Yu Yamada
- Department of Cardiovascular Surgery, Sakai City Medical Center, Ebaraji-cho 1-1-1, Nishi-ku, Sakai, Osaka, 593-8304, Japan
| | - Toshihiro Ohata
- Department of Cardiovascular Surgery, Sakai City Medical Center, Ebaraji-cho 1-1-1, Nishi-ku, Sakai, Osaka, 593-8304, Japan.
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Sakai City Medical Center, Ebaraji-cho 1-1-1, Nishi-ku, Sakai, Osaka, 593-8304, Japan
| | - Hisakazu Kohata
- Department of Critical Care Medicine, Sakai City Medical Center, Ebaraji-cho 1-1-1, Nishi-ku, Sakai, Osaka, 593-8304, Japan
| | - Junji Kumasawa
- Department of Critical Care Medicine, Sakai City Medical Center, Ebaraji-cho 1-1-1, Nishi-ku, Sakai, Osaka, 593-8304, Japan
| | - Michihiko Kohno
- Department of Critical Care Medicine, Sakai City Medical Center, Ebaraji-cho 1-1-1, Nishi-ku, Sakai, Osaka, 593-8304, Japan
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Cheng LTW, Sim TB, Kuan WS. Noninvasive Ventilation as a Temporizing Measure in Critical Fixed Central Airway Obstruction: A Case Report. J Emerg Med 2018; 54:615-618. [PMID: 29482923 DOI: 10.1016/j.jemermed.2017.12.059] [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: 07/07/2017] [Revised: 10/30/2017] [Accepted: 12/30/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Critical central airway obstruction (CAO) requires emergent airway intervention, but current guidelines lack specific recommendations for airway management in the emergency department (ED) while awaiting rigid bronchoscopy. There are few reports of the use of noninvasive ventilation (NIV) in tracheomalacia, but its use as a temporizing treatment option in fixed, malignant CAO has not, to the best of our knowledge, been reported. CASE REPORT An 84-year-old woman presented to the ED in respiratory distress, too breathless to speak and using her accessory muscles of respiration, with bilateral rhonchi throughout the lung fields. Point-of-care arterial blood gas revealed severe hypercapnia, and NIV was initiated to treat a presumed bronchitis with hypercapnic respiratory failure. Chest radiography revealed a paratracheal mass with tracheal deviation and compression. A diagnosis of critical CAO was made. While arranging for rigid bronchoscopic stenting, the patient was kept on NIV to good effect. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recommendations for emergent treatment of life-threatening, critical CAO before bronchoscopic intervention are not well established. Furthermore, reports of NIV use in CAO are rare. We suggest that emergency physicians consider NIV as a temporizing measure for critical CAO while awaiting availability of bronchoscopy.
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Affiliation(s)
- Lenard Tai Win Cheng
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Tiong Beng Sim
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Park JH, Shin JH, Kim KY, Lim JY, Kim PH, Tsauo J, Kim MT, Song HY. Respiratory support with venovenous extracorporeal membrane oxygenation during stent placement for the palliation of critical airway obstruction: case series analysis. J Thorac Dis 2017; 9:2599-2607. [PMID: 28932567 DOI: 10.21037/jtd.2017.06.88] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Venovenous extracorporeal membrane oxygenation (VV ECMO) is used to support gas transfer of patients suffering from respiratory failure during various procedures. The purpose of this study was to evaluate the technical feasibility and safety of fluoroscopic stent placement under respiratory support with VV ECMO in patients with critical airway obstructions. METHODS We reviewed the records of 17 patients (14 male and 3 female; mean age: 63 years; range, 30-82 years) who underwent self-expandable metallic stent (SEMS) placement under VV ECMO respiratory support for critical airway obstruction caused by malignant (n=16) or benign (n=1) etiology. RESULTS Fluoroscopic placement of SEMS was successful in all patients (100%) with no procedure-related complications. During a mean follow-up of 83 days (range, 10-367 days), 15 (88.2%) of 17 patients showed improvement of Hugh-Jones grades (from 4.7±0.4 to 3.1±0.9, P<0.001). Removal of the endotracheal tube was possible in 11 (84.6%) of 13 patients. Weaning off ECMO was successful in all patients. The ECMO-related and stent-related complication rates were 11.7% (n=2) and 29.4% (n=5), respectively, all successfully managed by additional interventions. Indications for VV ECMO included failure of mechanical ventilation in 13 (76.5%) patients, and orthopnea in 4 (23.5%) patients. CONCLUSIONS Fluoroscopic stent placement under VV ECMO respiratory support can be successfully performed in patients with critical airway obstruction, especially in cases of respiratory distress despite ventilation support and an inability to lie in a supine position. However, further studies will be needed to validate the standardized methods and specific indications.
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Affiliation(s)
- Jung-Hoon Park
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.,Departments of Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Kun Yung Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Ju Yong Lim
- Departments of Thoracic surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Pyeong Hwa Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Jiaywei Tsauo
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Min Tae Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Ho-Young Song
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
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Medhi J, Handique A, Goyal A, Lynser D, Phukan P, Sarma K, Padmanabhan A, Saikia MK, Chutia H. Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique. Indian J Radiol Imaging 2016; 26:103-7. [PMID: 27081233 PMCID: PMC4813059 DOI: 10.4103/0971-3026.178357] [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: 11/04/2022] Open
Abstract
PURPOSE To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. MATERIALS AND METHODS We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. RESULTS We achieved technical success in all the three patients with immediate relief of dyspnea. CONCLUSION Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort.
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Affiliation(s)
- Jayanta Medhi
- Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Akash Handique
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Donbok Lynser
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Pranjal Phukan
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Kalyan Sarma
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Aswin Padmanabhan
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Manuj Kumar Saikia
- Department of Cardiothoracic and Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Happy Chutia
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Hong SH, Moon YE, Lee SR, Cho SJ, Kwon OK. Anesthetic management for the insertion of a self-expandable metallic tracheal stent under venovenous extracorporeal membrane oxygenation. Korean J Anesthesiol 2012; 63:569-70. [PMID: 23277823 PMCID: PMC3531541 DOI: 10.4097/kjae.2012.63.6.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Tracheal stenosis may occur secondary to trauma, tumors, infection, inflammatory diseases, or iatrogenic causes. Understanding these lesions requires a basic understanding of the physics of airflow. All of these patients must be carefully evaluated and require a series of tests, including pulmonary function tests and radiographic studies. Treatment of tracheal lesions is a multidisciplinary issue and requires the close participation of interventional pulmonologists, anesthesiologists, and surgeons.
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Affiliation(s)
- Geraldine Daumerie
- Department of Anesthesiology, Hospital of the University of Pennsylvania, University of Pennsylvania, 680 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Cho JW, Jeong MA, Choi JH, Cho JW, Lee HJ, Kim DW, Kim KS, Seo JK. Anesthetic consideration for patients with severe tracheal obstruction caused by thyroid cancer -A report of 2 cases-. Korean J Anesthesiol 2010; 58:396-400. [PMID: 20508799 PMCID: PMC2876863 DOI: 10.4097/kjae.2010.58.4.396] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 06/22/2009] [Accepted: 07/08/2009] [Indexed: 11/25/2022] Open
Abstract
To achieve safe airway management, it is essential first to predict whether there will be difficulties in intubating or ventilating the patient's airway. An enlarged thyroid mass can produce a tracheal obstruction by compression or intraluminal invasion or both. We report two patients with thyroid cancer that obstructed the trachea by compression or invasion. There was no difficulty in endotracheal intubation of the patients with marked thyroid enlargement or in securing passage of the endotracheal tube through the compressed or narrowed portion of the trachea.
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Affiliation(s)
- Joong Woon Cho
- Department Anesthesiology and Pain Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Korea
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Lin YT, Zuo Z, Lo PH, Hseu SS, Chang WK, Chan KH, Yuan HB. Bilateral tension pneumothorax and tension pneumoperitoneum secondary to tracheal tear in a patient with relapsing polychondritis. J Chin Med Assoc 2009; 72:488-91. [PMID: 19762318 DOI: 10.1016/s1726-4901(09)70413-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare disease that is characterized by recurrent inflammation and destruction of cartilage and connective tissues. RP can have significant airway pathology that may require procedures to maintain airway patency and thus may have serious implications for anesthesiologists. Anesthesiologists must be prepared to deal with the possible complications that may occur during airway manipulation in patients with RP. Here, we present a case of life-threatening bilateral tension pneumothorax and tension pneumoperitoneum that developed after a tracheal tear during Montgomery T-tube insertion in a patient with tracheal stenosis due to RP. Correct diagnosis was delayed due to a misdiagnosis of airway obstruction. As a result, we emphasize that bilateral tension pneumothorax should be considered during refractory cardiac arrest in patients with increased airway pressure. A high index of suspicion and adequate management are mandatory for patients to survive these life-threatening complications.
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Affiliation(s)
- Yu-Ting Lin
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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