One-lung ventilation in a patient with stenting for tracheobronchial stenosis caused by esophageal cancer

Abstract

We have provided general anesthesia for a 53-year-old man scheduled to undergo lymph node removal for right mediastinal lymph node metastases caused by esophageal cancer. One year prior, acute respiratory failure occurred because of stenosis of the carinal bifurcation resulting from advanced esophageal cancer with tracheal invasion. The patient underwent placement of tracheobronchial stents (Spiral Z Stent) in two locations (left main bronchus and trachea/right main bronchus), followed by radiotherapy and chemotherapy. In the present case, after an 8.5-mm-ID tracheal tube was placed under bronchoscopic guidance, a 7.0 Fr. bronchial blocker (Arndt Endobronchial Blocker; Cook, Bloomington, IN, USA) was carefully inserted into the stent in the right main bronchus. Next, 3 ml air was injected into the blocker cuff, and left-sided one-lung ventilation was performed. After surgery was completed, the bronchial blocker was removed under bronchoscopic guidance. We confirmed there was no tracheobronchial injury nor stent displacement or deformation, then removed the tracheal tube. Even in patients with tracheobronchial stent placement, one-lung ventilation can be safely and reliably performed by selecting an appropriate bronchial blocker, along with careful insertion into the stent and frequent checking of the blocker position.

Effects of Different Anesthetic and Analgesic Methods on Cellular Immune Function and Stress Hormone Levels in Patients Undergoing Esophageal Cancer Surgery

“…Many reports have shown that surgical stress inhibition is mainly due to T lymphocyte-mediated cellular immunity, which also has a direct impact on the incidence of postoperative infection and tumor metastasis [16,17]. A good anesthetic method can reduce the perioperative stress response of patients and protect their immune function [17][18][19][20][21]. Because the degree of cellular immunosuppression during the perioperative period is mainly affected by the size and time of surgical trauma of patients, thoracotomy poses a greater impact on the patient's respiratory and circulatory system [22].…”

Palliative Radiotherapy for Malignant Airway Obstruction Requiring Mechanical Ventilation: Answer or Anguish?

“…Finally, information on endof-life care issues in their patient population and mode of MV, such as single lung versus double lung, pressure cycled versus volume cycled, and standard versus high-frequency ventilation, would have addressed some practical issues for clinicians and intensivist. 5 We believe that further clinical studies will provide more understanding of the role of RT in MAO requiring MV. This study has indeed paved the way to this understanding and we would like to commend the authors for this work.…”

Recurrent Laryngeal Nerve Monitoring during Thoracoscopic Esophagectomy

“…Although the double lumen endotracheal tube is the first choice in one‐lung ventilation, there are certain cases when intubation with a double‐lumen endotracheal tube is not possible. In those cases, bronchial blockers are ideal devices [24].…”