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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ly NM, Van Dinh N, Trang DTT, Hai NV, Hung TX. Apnoeic oxygenation with high-flow oxygen for tracheal resection and reconstruction surgery. BMC Anesthesiol 2022; 22:73. [PMID: 35303828 PMCID: PMC8932011 DOI: 10.1186/s12871-022-01610-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/04/2022] [Indexed: 12/18/2022] Open
Abstract
Background Tracheal resection and reconstruction are the most effective treatments for tracheal stenosis, but the difficulties are surgery and maintaining ventilation performed on the patient’s same airway. High-flow oxygen has begun to be applied to prolong the apnoea time in the tracheal anastomosis period for tracheal resection and reconstruction. This study aims to evaluate the effectiveness of apneic conditions with high-flow oxygen as the sole method of gas exchange during anastomosis construction. Methods A prospective study was performed on 16 patients with tracheal stenosis, with ages ranging from 19 to 70, who underwent tracheal resection and reconstruction from April 2019 to August 2020 in 108 Military Central Hospital. During the anastomosis phase using high flow oxygen of 35–40 l.min-1 delivered across the open tracheal with an endotracheal tube (ETT) at the glottis in apnoeic conditions. Results The mean (SD) apnoea time was 20.91 (2.53) mins. Mean (SD) time anastomosis was 22.9 (2.41) mins. The saturation of oxygen was stable during all procedures at 98–100%. Arterial blood gas analysis showed mean (SD) was hypercapnia and acidosis acute respiratory after 10 mins of apnoea and 20 mins apnoea respectively. However, after 15 mins of ventilation, the parameters are ultimately returned to normal. All 16 patients were extubated early and safely at the end of the operation. There were no complications, such as bleeding, hemothorax, pneumothorax, or barotrauma. Conclusion High-flow oxygen across the open tracheal under apnoeic conditions can provide a satisfactory gas exchange to allow tubeless anesthesia for tracheal resection and reconstruction.
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Affiliation(s)
- Nguyen Minh Ly
- Department of Anesthesiology and Pain Medicine, 108 Military Central Hospital, No.1 Tran Hung Dao Street, Hai Ba Trung District, Ha Noi City, 100000, Vietnam
| | - Ngo Van Dinh
- Department of Anesthesiology and Pain Medicine, 108 Military Central Hospital, No.1 Tran Hung Dao Street, Hai Ba Trung District, Ha Noi City, 100000, Vietnam
| | - Dinh Thi Thu Trang
- Department of Anesthesiology and Pain Medicine, 108 Military Central Hospital, No.1 Tran Hung Dao Street, Hai Ba Trung District, Ha Noi City, 100000, Vietnam
| | - Ngo Vi Hai
- Department of Thoracic surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Tong Xuan Hung
- Department of Anesthesiology and Pain Medicine, 108 Military Central Hospital, No.1 Tran Hung Dao Street, Hai Ba Trung District, Ha Noi City, 100000, Vietnam.
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Krecmerova M, Schutzner J, Michalek P, Johnson P, Vymazal T. Laryngeal mask for airway management in open tracheal surgery-a retrospective analysis of 54 cases. J Thorac Dis 2018; 10:2567-2572. [PMID: 29997917 DOI: 10.21037/jtd.2018.04.73] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Airway management in tracheal resections presents many challenges. The aim of this retrospective analysis is to report the efficacy and complications associated with the use of the laryngeal mask airway in this procedure. Methods The charts of 54 consecutive patients operated for tracheal stenosis during the period 2009-2016 were reviewed. This cohort included only resections of the trachea. We evaluated total success rate of laryngeal mask insertion (%), insertion success rate on the first attempt, the quality of intraoperative ventilation through the laryngeal mask, the quality of fibre optic view through the device, incidence of bleeding during the first 24 h, signs of dehiscence of the anastomosis within 48 h and 30-day mortality. Results The laryngeal mask airway provided a patent airway throughout the procedure in 52 (96.4%) patients. Insertion of the device failed in 1 (1.8%) patient due to abnormal upper airway anatomy. Another patient (1.8%) developed laryngeal mask malposition during intraoperative neck extension subsequently requiring tracheal intubation. Fibre optic view through the devices including insertion of the flexible bronchoscope was satisfactory in 52 (96.4%) patients. Serious complications, such as pulmonary aspiration, early postoperative bleeding or suture dehiscence were not observed in this cohort. Conclusions Based on this analysis of 54 patients, we would consider the laryngeal mask airway a feasible alternative to the tracheal tube for airway management and ventilation during open tracheal surgery.
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Affiliation(s)
- Martina Krecmerova
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Jan Schutzner
- Department of Surgery, 1st School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Pavel Michalek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Paul Johnson
- Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Tomas Vymazal
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
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Malpas G, Hung O, Gilchrist A, Wong C, Kent B, Hirsch GM, Hart RD. The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review. Can J Anaesth 2018; 65:685-97. [DOI: 10.1007/s12630-018-1099-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022] Open
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Soeda R, Taniguchi F, Sawada M, Hamaoka S, Shibasaki M, Nakajima Y, Hashimoto S, Sawa T, Nakayama Y. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis. Case Rep Anesthesiol 2016; 2016:6871565. [PMID: 26989518 DOI: 10.1155/2016/6871565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/28/2016] [Indexed: 12/15/2022] Open
Abstract
A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.
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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.
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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
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Villanueva C, Milder D, Manganas C. Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection. Heart Lung Circ 2015; 24:e86-8. [DOI: 10.1016/j.hlc.2015.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 01/07/2015] [Accepted: 01/23/2015] [Indexed: 11/26/2022]
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Gao H, Zhu B, Yi J, Ye TH, Huang YG. Urgent tracheal resection and reconstruction assisted by temporary cardiopulmonary bypass: a case report. ACTA ACUST UNITED AC 2013; 28:55-7. [PMID: 23527809 DOI: 10.1016/s1001-9294(13)60020-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Severe tracheal stenosis can not only cause critical medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on the physicians, particularly the anesthesiologist. Life-threatening airway obstruction can make the patient's gas exchange extremely difficult.Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis. Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists. In these cases, airway management is the top issue for the anesthesiologist, and the level of difficulty varies with stenosis location, severity of stenosis, and surgical technique. Extracorporeal membrane oxygenation (ECMO), or cardiopulmonary bypass (CPB), is rarely utilized for the surgery, but for those impossible airways due to nearly complete tracheal obstruction, ECMO or CPB could be the final choice for anesthesiologists. Here we report a case of successful urgent airway management for tracheal resection and reconstruction assisted by temporary CPB.
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Affiliation(s)
- Hui Gao
- Department of Anesthesiology, Chinese Academy of Medical Sciences, Beijing, China
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Padhy K, Rama Narsimham SB, Chandrahas PR, Chandra Murthy GSR, Satyanarayana PV. Tracheal reconstruction with mitral valve replacement under cardiopulmonary bypass: A case report. Indian J Thorac Cardiovasc Surg 2009; 25:208-10. [DOI: 10.1007/s12055-009-0049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
The use of cardiopulmonary bypass (CPB) in noncardiac surgical settings has been increasingly developed and has greatly benefited noncardiac surgeon. A few years after the advent of CPB as well as profound hypothermic circulatory arrest in the early years, it was employed by neurosurgeons in cerebrovascular surgery and by general thoracic surgeons in carinal tumor resection. Indications for CPB were extended and modified year after year. It has facilitated not only the surgical management by surgeons of lesions that cannot be managed safely and effectively by conventional techniques, or conventional techniques carry significant risks to the patient, but also the preservation of the viability of multiple organ procurement, the practice of isolated limb perfusion for the treatment of malignancies of the extremities, and emergent cardiopulmonary resuscitation. Owing to the complications arising from CPB and profound hypothermic circulatory arrest, such as postoperative bleeding, coagulopathy, and neurologic deficits, efforts have been made to avoid these common hazards. Thus, innovative techniques including extracorporeal membrane oxygenation, percutaneous cardiopulmonary support, venovenous bypass, normothermic CPB, and minimally invasive approaches have emerged and played an important role as alternatives of standard CPB in decreasing morbidity and mortality and improving survival.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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Abstract
Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circulation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anesthetic management. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.
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Abstract
Anaesthesia for tracheal resection requires careful planning by an experienced team. We report a case of urgent tracheal resection for a vascular tumor in a 41-year-old man who was a heavy smoker The tumour occupied most of his trachea. A CT reconstruction of the tumor assisted in planning. Perioperative tracheal laser therapy and cardiopulmonary bypass were not used due to concerns about excessive bleeding. Intraoperative airway management involved an upper endotracheal tube placed by the anaesthetist and a second, lower, endotracheal tube placed by the surgeon. The existing evidence for anaesthesia management of tracheal resection is currently limited to case reports. This case illustrates how preoperative imaging and careful planning can lead to a successful outcome, despite the potentially life-threatening nature of the pathology and the surgery.
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Affiliation(s)
- T Zhong
- Department of Anesthesia, Sir Run Run Shaw Hospital, Hangzhou, China
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