Anesthesia for airway surgeries under the perioperative venovenous extracorporeal membrane oxygenation - Three case reports -

Abstract

The airway management for patients with critical airway problems continues to be a challenge to the anesthesiologist. In general cases, conventional ventilation techniques have been used successfully. These include fiberoptic bronchoscope guided intubation, supraglottic airway, endotracheal or endobronchial intubation at operative field, high frequency jet ventilation, etc. However, patients with near-fatal airway obstruction or severely depressed pulmonary function that is refractory to conventional ventilation methods also present. In these cases, cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO) can be used. Although these situations are uncommon indications for ECMO, ECMO can be a potential option for these life threatening conditions. Especially, venovenous (VV) ECMO can be used for pure pulmonary support. We describe three cases of airway surgery requiring ECMO. VV ECMO was established in all cases. ECMO provided adequate temporary pulmonary support and all patients weaned from ECMO successfully without any complication.

Awake nasotracheal intubation under bronchoscopic guidance and anesthetic management in a patient undergoing excision of an endotracheal mass

“…In addition, there are fewer back-up options after failed intubation under anesthesia compared to the awake state. [ 2 , 6 ] ECMO may solve the above-mentioned airway problems, [ 7 ] but we did not use ECMO as a first option because we were concerned about the complications related to its use, such as heparin-induced bleeding, vascular injury, and limb ischemia. [ 8 ] Instead, we had the ECMO on standby, for use in emergency situations.…”