Airway management for right thoracoscopic tracheal tumour resection after left pneumonectomy assisted by cardiopulmonary bypass: a case report.
Cardiopulmonary bypass
Pneumonectomy
Tracheal tumour
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
received:
19
05
2024
accepted:
12
09
2024
medline:
2
10
2024
pubmed:
2
10
2024
entrez:
1
10
2024
Statut:
epublish
Résumé
The incidence of secondary tracheal tumours following lung cancer surgery is notably low. Patients with tracheal tumours typically present with symptoms such as coughing, sputum production, haemoptysis, wheezing, stridor, and dyspnoea. In cases of peripheral structure invasion, symptoms may further extend to hoarseness and dysphagia. Initial symptoms may be notably non-distinct. However, the development of pronounced airway symptoms often signifies a critical condition. A 70-year-old male with severe chest tightness and asthma was transferred to our hospital for emergency treatment. He had undergone left pneumonectomy for non-small cell carcinoma of the left upper lobe of the lung 3 years prior. The examination confirmed that a secondary tumour originated from the left main bronchus and extended to the carina, occupying 90% of the diameter of the tracheal lumen. To relieve the patient's emergency airway, we chose right thoracoscopic resection of the tracheal tumour assisted by cardiopulmonary bypass (CPB), which provides extracorporeal lung support and a good surgical field. In patients with secondary tracheal tumours after left pneumonectomy for lung cancer, perioperative airway management is challenging for anaesthesiologists, and patients' oxygenation should receive close attention. This article describes the airway management process of this patient for reference.
Sections du résumé
BACKGROUND
BACKGROUND
The incidence of secondary tracheal tumours following lung cancer surgery is notably low. Patients with tracheal tumours typically present with symptoms such as coughing, sputum production, haemoptysis, wheezing, stridor, and dyspnoea. In cases of peripheral structure invasion, symptoms may further extend to hoarseness and dysphagia. Initial symptoms may be notably non-distinct. However, the development of pronounced airway symptoms often signifies a critical condition.
CASE PRESENTATION
METHODS
A 70-year-old male with severe chest tightness and asthma was transferred to our hospital for emergency treatment. He had undergone left pneumonectomy for non-small cell carcinoma of the left upper lobe of the lung 3 years prior. The examination confirmed that a secondary tumour originated from the left main bronchus and extended to the carina, occupying 90% of the diameter of the tracheal lumen. To relieve the patient's emergency airway, we chose right thoracoscopic resection of the tracheal tumour assisted by cardiopulmonary bypass (CPB), which provides extracorporeal lung support and a good surgical field.
CONCLUSION
CONCLUSIONS
In patients with secondary tracheal tumours after left pneumonectomy for lung cancer, perioperative airway management is challenging for anaesthesiologists, and patients' oxygenation should receive close attention. This article describes the airway management process of this patient for reference.
Identifiants
pubmed: 39354615
doi: 10.1186/s13019-024-03053-7
pii: 10.1186/s13019-024-03053-7
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
578Informations de copyright
© 2024. The Author(s).
Références
Piorek A, Pluzanski A, Teterycz P, Tabor S, Winiarczyk K, Knetki-Wroblewska M, Kowalski DM. Krzakowski M.Clinicopathological characteristics of patients with primary tracheal tumors: analysis of eighty-nine cases. Thorac Cancer. 2024;15(11):878–83.
doi: 10.1111/1759-7714.15231
pubmed: 38429910
pmcid: 11016403
Chong S, Kim TS, Han J. Tracheal metastasis of lung cancer: CT findings in six patients. AJR Am J Roentgenol. 2006;186(1):220–4.
doi: 10.2214/AJR.04.1711
pubmed: 16357405
Moreno P, Lang G, Taghavi S, Aigner C, Marta G, De Palma A, Klepetko W. Right-sided approach for management of left-main-bronchial stump problems.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery.2011;40(4):926 – 30.
Lei J, Su K, Li XF, Zhou YA, Han Y, Huang LJ. Wang XP.ECMO-assisted carinal resection and reconstruction after left pneumonectomy. J Cardiothorac Surg. 2010;5:89.
doi: 10.1186/1749-8090-5-89
pubmed: 20961431
pmcid: 2974678
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. 2021;35(5):1524–33.
doi: 10.1053/j.jvca.2020.11.041
pubmed: 33339662
Yu W, Zhou P, Chen K, Tang W, Xia Q, Ma J. Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway: a case report. Medicine. 2020;99(11):e19488.
doi: 10.1097/MD.0000000000019488
pubmed: 32176086
pmcid: 7440192
Woods FM, Neptune WB, Palatchi A. Resection of the carina and main-stem bronchi with the use of extracorporeal circulation. N Engl J Med. 1961;264:492–4.
doi: 10.1056/NEJM196103092641006
pubmed: 13786569
Slama A, Stork T, Collaud S, Aigner C. Current use of extracorporeal life support in airway surgery: a narrative review. J Thorac Disease. 2023;15(7):4101–10.
doi: 10.21037/jtd-22-1483
Bonnin M, Therre P, Albuisson E, Beaujard H, Barthelemy I, Mondie JM, Bazin JE. Comparison of a propofol target-controlled infusion and inhalational sevoflurane for fibreoptic intubation under spontaneous ventilation. Acta Anaesthesiol Scand. 2007;51(1):54–9.
doi: 10.1111/j.1399-6576.2006.01186.x
pubmed: 17073850
Liao R, Li JY, Liu GY. Comparison of sevoflurane volatile induction/maintenance anaesthesia and propofol-remifentanil total intravenous anaesthesia for rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal in children. Eur J Anaesthesiol. 2010;27(11):930–4.
doi: 10.1097/EJA.0b013e32833d69ad
pubmed: 20683333
Cabrini L, Baiardo Redaelli M, Ball L, Filippini M, Fominskiy E, Pintaudi M, Putzu A, Votta CD, Sorbello M, Antonelli M, Landoni G, Pelosi P, Zangrillo A. Awake fiberoptic intubation protocols in the operating room for anticipated difficult Airway: a systematic review and Meta-analysis of Randomized controlled trials. Anesth Analg. 2019;128(5):971–80.
doi: 10.1213/ANE.0000000000004087
pubmed: 30896601