Anesthetic Management of Upper Tracheal Cancer Resection and Reconstruction: A Case Report

Abstract

Tracheal tumor resection and reconstruction is the primary treatment for tracheal tumors. The trachea is the surgical site as well as an important channel to ensure ventilation and maintain oxygenation during surgery. In this report, we describe the successful management of an upper tracheal tumor in a 50-year-old patient. The tumor was situated approximately 2-3 cm below the vocal cords, occluding the tracheal lumen by 80%. Conventional orotracheal intubation was expected to be impossible, and the patient was managed with an I-Gel supraglottic airway for mechanical ventilation with the assistance of venovenous extracorporeal membrane oxygenation (VV ECMO). After securing tracheal intubation via the tracheostomy site, VV ECMO was weaned off, and mechanical ventilation was changed to tracheal intubation. Eventually, tracheal tumor resection and reconstruction were successfully performed under general anesthesia. No specific events occurred during anesthetic management. Careful preoperative planning and good teamwork made the procedure possible without complications.

Anesthetic management of thyroid carcinoma invading the upper tracheal segment: A case report

“…Furthermore, there are numerous viable approaches for airway management in patients with tracheal tumors. I-Gel, when used in conjunction with extracorporeal membrane oxygenation (ECMO) [ 6 ] and high-frequency jet ventilation (HFJV) [ 7 ], holds promising potential as an effective strategy for providing intraoperative oxygenation support in patients undergoing surgery for tracheal tumors. Various methods have pros and cons.…”

Anaesthetic management of a bleeding intratracheal mass

“…In a case report by Choi et al where an upper tracheal tumor obscured the passage of endotracheal tube, veno-venous ECMO (extra-corporeal membrane oxygenation) was used till tracheostomy access was achieved. 3 There have been a few sporadic case reports of thyroid tumor presenting as haemoptysis. This aggressive presentation, however, remains uncommon.…”

Current use of extracorporeal life support in airway surgery: a narrative review

“…The most common indication for airway surgery using ECLS was primary malignancy of the airways, with 27% of cases in the literature (n=45/168). The histological subtypes were: squamous cell carcinoma (SCC) in 15 cases ( 18 , 36 , 37 ), adenoid cystic carcinoma (ACC, n=10) ( 7 , 15 , 24 ), neuroendocrine tumor (NET, n=3) ( 5 , 18 ), sarcoma (n=2) ( 31 , 38 ), mucoepidermoid carcinoma (MEC, n=2) ( 12 , 21 ) and adenocarcinoma (n=1) ( 39 ). Based on tumor localization, the type of resections was: carinal resection (n=16), segmental tracheal resection (n=9), pulmonary bronchial sleeve resections w/o carina (n=10), airway replacement with stented aortic matrices (n=4), left main bronchus resection w/o (Hemi-)carina (n=3) and resection of the membranous tracheal wall (n=3).…”

“…When there is a risk of total airway obstruction and subsequent anoxia during induction of anesthesia ( 45 ), ECLS should be initiated under local anesthesia. In these cases of awake initiation ( 24 , 46 , 47 ), the mode (peripheral V-A or V-V) should be chosen solely dependent on hemodynamic considerations ( 2 , 34 , 48 , 49 ). Nevertheless, in most reported cases, patients were stable before induction of anesthesia, and the airways could be secured to maintain ventilation.…”