1
|
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.
Collapse
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
| |
Collapse
|
2
|
Cancer treatment and decision making in individuals with intellectual disabilities: a scoping literature review. Lancet Oncol 2022; 23:e174-e183. [DOI: 10.1016/s1470-2045(21)00694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
|
3
|
Kim J, Park BY, Lim JA. Awake nasotracheal intubation under bronchoscopic guidance and anesthetic management in a patient undergoing excision of an endotracheal mass: A case report. Medicine (Baltimore) 2021; 100:e27734. [PMID: 34766581 PMCID: PMC10545392 DOI: 10.1097/md.0000000000027734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The main challenge facing anesthesiologists during endotracheal mass resection is securing effective airway management during surgery. It is important to select an airway intubation and airway maintenance method according to the patient's condition and the characteristics of the mass. PATIENT CONCERNS A 74-year-old woman with aggravated dyspnea for 1 year was scheduled to undergo endotracheal mass excision under general anesthesia. DIAGNOSIS The mass was 4 × 3 × 3 cm ovoid-shaped, and located 4 cm above the carina, occupying 41% of the tracheal lumen in a preoperative chest computed tomography and bronchoscopy. INTERVENTIONS After preparing extracorporeal membrane oxygenation in case of the inability to ventilate and intubate, we attempted awake bronchoscopy-guided nasotracheal intubation using a reinforced endotracheal tube with an inner diameter of 5.5 mm and outer diameter of 7.8 mm after a translaryngeal block. The tube was passed around the mass without resistance and placed right above the carina. With the tube pulled back above the mass, another tube was introduced from the opened trachea below the mass to the right main bronchus. Following the resection of the tracheal portion containing the mass, the posterior wall of the remaining trachea was reconstructed. The tube placed in the right main bronchus was removed and the tube in the upper trachea was introduced right above the carina. The patient's head was kept flexed once the anastomosis of the trachea was completed, and the surgery ended uneventfully. OUTCOMES The mass was confirmed as schwannoma by histopathological finding. The patient was discharged from the hospital on the 6th postoperative day without complication. LESSONS Awake bronchoscopy-guided intubation is a safe airway management method in patients with an endotracheal mass. Close cooperation between anesthesiologist and surgeon, and preparation for airway management before surgery is essential. It is necessary to establish alternative plans that can be implemented in the case that intubation and ventilation are not possible.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Zhu GQ, Wu XM, Cao DH. High frequency jet ventilation at the distal end of tracheostenosis during flexible bronchoscopic resection of large intratracheal tumor: Case series. Medicine (Baltimore) 2020; 99:e19929. [PMID: 32569155 PMCID: PMC7310889 DOI: 10.1097/md.0000000000019929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/04/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Resection of a large intratracheal tumor with severe obstruction via flexible bronchoscope remains a formidable challenge to anesthesiologists. Many artificial airways positioned proximal to tracheal obstruction can not ensure adequate oxygen supply. How to ensure effective gas exchange is crucial to the anesthetic management. PATIENT CONCERNS Five patients of intratracheal tumor occupying 70% to 85% of the tracheal lumen were scheduled for tumor resection via flexible bronchoscope. DIAGNOSIS The patients were diagnosed with intratracheal tumor based on their symptoms, radiographic findings and tracheoscopy. INTERVENTIONS We describe a technique of high frequency jet ventilation (HFJV) using an endobronchial suction catheter distal to tracheostenosis during the surgery, which ensured the good supply of oxygen. We applied general anesthesia with preserved spontaneous breathing. A comprehensive anesthesia protocol that emphasizes bilateral superior laryngeal nerve (SLN) block and sufficient topical anesthesia. An endobronchial suction catheter was introduced transnasally into the trachea and then advanced through the tracheostenosis with the tip proximal to the carina under direct vision with the aid of fiber bronchoscope. HFJV was then performed through the suction catheter. OUTCOMES The SPO2 maintained above 97% during the surgery. Carbon dioxide retention was alleviated obviously when adequate patency of the trachea lumen achieved about 30 min after the beginning of surgery. HFJV was ceased and all patients had satisfactory spontaneous breathing at the end of the procedure. CONCLUSION HFJV at the distal end of tracheostenosis is a suitable ventilation strategy during flexible bronchoscopic resection of a large intratracheal tumor.
Collapse
Affiliation(s)
| | - Xiao-Mai Wu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | | |
Collapse
|
6
|
Kar P, Malempati AR, Durga P, Gopinath R. Institution of cardiopulmonary bypass in an awake patient for resection of tracheal tumor causing near total luminal obstruction. J Anaesthesiol Clin Pharmacol 2018; 34:409-411. [PMID: 30386033 PMCID: PMC6194819 DOI: 10.4103/joacp.joacp_352_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Prachi Kar
- Department of Anesthesia and Intensive Care, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Amaresh Rao Malempati
- Department of CTVS, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Padmaja Durga
- Department of Anesthesia and Intensive Care, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ramachandran Gopinath
- Department of Anesthesia and Intensive Care, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
7
|
Garg R, Saini S, Kumar V, Gupta N. Emergency airway management of intratracheal tumor in a patient with respiratory distress. J Anaesthesiol Clin Pharmacol 2017; 33:133-134. [PMID: 28413295 PMCID: PMC5374822 DOI: 10.4103/0970-9185.168258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Rakesh Garg
- Department of Anesthesiology and Palliative Care, Dr. Brairch, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Dr. Rakesh Garg, Department of Anaesthesiology, DR. Brairch, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | - Shalini Saini
- Department of Anesthesiology and Palliative Care, Dr. Brairch, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Anesthesiology and Palliative Care, Dr. Brairch, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Anesthesiology and Palliative Care, Dr. Brairch, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
8
|
Uma B, Kochhar A, Verma UC, Rautela RS. Anesthetic management for bronchoscopy and debulking of obstructing intratracheal tumor. Saudi J Anaesth 2015; 9:484-8. [PMID: 26543475 PMCID: PMC4610102 DOI: 10.4103/1658-354x.165129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary tracheal tumors comprise a rare group of benign and malignant tumors. Bronchoscopy is required for diagnosis and staging of tracheal neoplasms as well as debulking of the tumor. The management of anesthesia for rigid bronchoscopy in a patient with tracheal neoplasm presents with many challenges to the anesthetist. We present anesthetic management of an 18-year-old female who presented with orthopnea. Computed tomography scan of the thorax revealed a polypoidal lesion in the trachea proximal to carina and consolidation in the right middle lobe. The patient was scheduled for rigid bronchoscopy and debulking of the tumor. Case was successfully managed by providing positive pressure ventilation and oxygenation during rigid bronchoscopy using manual ventilation through the side port of the rigid bronchoscope. The procedure was uneventful, and patient improved symptomatically in the immediate postoperative period. The successful management of this case demonstrates the airway management in a patient with tracheal tumor for rigid bronchoscopy.
Collapse
Affiliation(s)
- B Uma
- Department of Cardiac Anesthesia, AIIMS, New Delhi, India
| | - Anjali Kochhar
- Department of Anesthesia, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - U C Verma
- Department of Anesthesia, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - R S Rautela
- Department of Anesthesia, University College of Medical Sciences and GTB Hospital, New Delhi, India
| |
Collapse
|
9
|
Saroa R, Gombar S, Palta S, Dalal U, Saini V. Low tracheal tumor and airway management: An anesthetic challenge. Saudi J Anaesth 2015; 9:480-3. [PMID: 26543474 PMCID: PMC4610101 DOI: 10.4103/1658-354x.159483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe a case presenting with tracheal tumor wherein a Microlaryngeal tube was advanced into the trachea distal to the tumor for primary airway control followed by cannulation of both endobronchial lumen with 5.5 mm endotracheal tubes to provide independent lung ventilation post tracheal transection using Y- connector attached to anesthesia machine. The plan was formulated to provide maximal surgical access to the trachea while providing adequate ventilation at the same time. A 32 yrs non smoker male, complaining of cough, progressive dyspnea and hemoptysis was diagnosed to have a broad based mass in the trachea on computed tomography of chest. Bronchoscopy of the upper airway confirmed presence of the mass at a distance of 9 cms from the vocal cords, obstructing the tracheal lumen by three fourth of the diameter. The patient was scheduled to undergo the resection of the mass through anterolateral thoracotomy. We recommend the use of extralong, soft, small sized microlaryngeal surgery tube in tumors proximal to carina, for securing the airway before the transection of trachea and bilateral endobronchial intubation with small sized cuffed endotracheal tubes for maintenance of ventilation after the transection of trachea in patients with mass in the lower trachea.
Collapse
Affiliation(s)
- Richa Saroa
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
| | - Sanjeev Palta
- Department of Anesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India
| | - Usha Dalal
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Varinder Saini
- Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
10
|
Affiliation(s)
- Archna Koul
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Gangaram Hospital, New Delhi, India
| | | |
Collapse
|
11
|
Sendasgupta C, Sengupta G, Ghosh K, Munshi A, Goswami A. Femoro-femoral cardiopulmonary bypass for the resection of an anterior mediastinal mass. Indian J Anaesth 2011; 54:565-8. [PMID: 21224977 PMCID: PMC3016580 DOI: 10.4103/0019-5049.72649] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The perioperative management of patients with mediastinal mass is challenging. Complete airway obstruction and cardiovascular collapse may occur during the induction of general anaesthesia, tracheal intubation, and positive pressure ventilation. The intubation of trachea may be difficult or even impossible due to the compressed, tortuous trachea. Positive pressure ventilation may increase pre-existing superior vena cava (SVC) obstruction, reducing venous return from the SVC causing cardiovascular collapse and acute cerebral oedema. We are describing here the successful management of a patient with a large anterior mediastinal mass by anaesthetizing the patient through a femoro-femoral cardiopulmonary bypass (fem-fem CPB).
Collapse
Affiliation(s)
- Chaitali Sendasgupta
- Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | | | | | | |
Collapse
|
12
|
Poulin V, Vaillancourt R, Somma J, Gagné N, Bussières JS. High frequency ventilation combined with spontaneous breathing during bronchopleural fistula repair: a case report. Can J Anaesth 2009; 56:52-6. [PMID: 19247778 DOI: 10.1007/s12630-008-9010-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 10/16/2008] [Accepted: 10/28/2008] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We report the addition of high frequency oscillatory ventilation (HFOV), combined with spontaneous breathing under general anesthesia, during an uncommon technique to occlude a late post-pneumonectomy bronchopleural fistula. CLINICAL FEATURES A 41-year-old woman underwent an extended right pneumonectomy with chest wall resection and prosthetic reconstruction for a large adenocarcinoma of the upper lobe (T3N0M0). Her postoperative recovery was satisfactory, and she subsequently received adjuvant chemotherapy. Four months later, however, she was readmitted for investigation of confusion and pink expectorations. On cerebral magnetic resonance imaging, a frontal metastasis with surrounding edema was discovered, as well as a possible secondary lesion in the occipital lobe. In view of the comorbidities, thoracoscopy was planned as an interim measure, with the goal being to debride the fistula and to seal the prosthetic plug. During this case, a HFOV system was used to allow an addition of 2.5 L.min(-1) of minute ventilation to the patient's spontaneous respiration, while maintaining eucapnia without increasing airway pressure. CONCLUSIONS With the addition of high frequency ventilation under general anesthesia in a patient with a persistent bronchopleural fistula, the PaCO(2) level was adequately controlled during the simultaneous use of fibreoptic bronchoscopy and video assisted thoracoscopy to facilitate a successful surgical repair.
Collapse
Affiliation(s)
- Véronique Poulin
- The Department of Anesthesiology, Laval University, Quebec City, Quebec, Canada
| | | | | | | | | |
Collapse
|
13
|
Abstract
Primary tracheal tumors in children are rare. We report the anesthetic management of a 9-year-old child undergoing resection of a midtracheal tumor obstructing approximately 73% of the tracheal lumen. To prepare for any possible airway emergency during the induction and maintenance of anesthesia, we ascertained preoperatively that a mini-tracheotomy tube could be inserted at the distal portion of the tracheal lesion. Oxygenation and ventilation were adequately maintained throughout the period of anesthesia. Anesthetic management for tracheal tumor resection should reflect the location of the tumor and the degree of tracheal obstruction.
Collapse
Affiliation(s)
- Yoshitaka Kawaraguchi
- Department of Anesthesia and Critical Care, Miyagi Children's Hospital, Sendai, Japan.
| | | |
Collapse
|