Anesthetic Management with PCPS for Tracheobronchial Stent Insertion

Abstract

A tracheobronchial stent insertion was scheduled under general anesthesia in a 67-year-old man with a gastric tube-bronchial fistula after esophagectomy for cancer. Because the duration of apnea was expected to be long, we decided to use percutaneous cardiopulmonary support (PCPS) for gas exchange. The catheter insertion for PCPS was done under spinal anesthesia to eliminate pain during the procedure. Total intravenous anesthesia was performed after PCPS started, and the patient was intubated orally. When the Y-stent was inserted through a rigid bronchoscope, the patient had to be extubated. After extubation, oxygen saturation in his right hand dropped temporarily, whereas that in his left hand remained at 100%. This discrepancy occurred because arterial blood that was not fully oxygenated circulated in his right limb due to cardiac output rather than PCPS. We could minimize this desaturation in the right limb by ventilating the right lung through intubation into the right main trachea. We were able to manage this patient without critical accidents through detailed planning and special attention under PCPS.

Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: A case report

“…In general, anesthesia management for rigid bronchoscopy is performed by the following two methods: one is to maintain the patient's spontaneous breathing, and the other is to administer muscle relaxants and perform controlled breathing. In high‐risk patients, such as those with bronchopleural fistulas, treatment with extracorporeal membrane oxygenation has been reported 5 . Although there is a study report that the incidence of hypoxic events was lower in the controlled breathing group, 6 as the silicon cap of the rigid scope head is removed during the procedure, this may cause apnea in patients undergoing controlled ventilation.…”

“…In high-risk patients, such as those with bronchopleural fistulas, treatment with extracorporeal membrane oxygenation has been reported. 5 Although there is a study report that the incidence of hypoxic events was lower in the controlled breathing group, 6 as the silicon cap of the rigid scope head is removed during the procedure, this may cause apnea in patients undergoing controlled ventilation. Therefore, at our institution, anesthesia is managed in most patients while maintaining spontaneous breathing.…”

Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: a case report

“…In general, anesthesia management for rigid bronchoscopy is performed by the following 2 methods: one is to maintain the patient's spontaneous breathing, and the other is to administer muscle relaxants and perform controlled breathing. In high-risk patients, such as those with bronchopleural fistulas, treatment with extracorporeal membrane oxygenation has been reported [5]. Although there is a study report that the incidence of hypoxic events was lower in the controlled breathing group [6], as the silicon cap of the rigid scope head is removed during the procedure, this may cause apnea in patients undergoing controlled ventilation.…”