SummaryThe use of extracorporeal membrane oxygenation in adults has increased in popularity and importance for the support of patients with cardiac or pulmonary failure. Although it is now quite commonly used in the intensive care unit, its use has rarely been described as a means of support during anaesthesia and surgery. We report the case of a patient who required curative resection of the oesophagus following previous left pneumonectomy where veno-venous extracorporeal membrane oxygenation was required both during surgery and for the first three days postoperatively. We describe the anaesthetic management of this patient who only had a single lung, review other alternatives and discuss why extracorporeal membrane oxygenation was particularly suited to this case. To the best of our knowledge, the anaesthetic literature to date does not contain a case report of this type. Case reportWe report the case of a 66-year-old male patient for whom oesophageal resection was planned. His clinical symptoms included mild dysphagia and weight loss of about 10 kg. The patient had undergone leftsided pneumonectomy 12 years previously, followed by chemotherapy and radiotherapy, for non-small lung cancer. His medical history also included left recurrent nerve palsy and mild fibrosis of the lower lobe of the right lung. Oesophagoscopy showed an exophytic ulcerating lesion extending from 24 to 26 cm; histology and endosonography confirmed a pT1N0M0 squamous cell carcinoma. The interdisciplinary tumour board conference agreed that only a radical oesophagectomy would provide a curative approach and the patient was referred for an anaesthetic assessment. The surgeons planned to perform the procedure in two stages: resection of the tumour via a right-sided thoracotomy with at least partial collapse of the only remaining lung, followed by extra-anatomical reconstruction in a separate operation.Pre-operative investigations included a normal echocardiographic study and stress-spirometry which revealed mildly reduced peak oxygen uptake and exercise capability. We decided that the safest anaesthetic approach would be to use extracorporeal membrane oxygenation (ECMO) to facilitate oxygenation and
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