Alfentanil and propofol induced anesthesia for patients with huge endotracheal tumor undergoing fiberoptic bronchoscopic interventional therapy: case report

Abstract

Background: There is a high risk of hypoxia or apnea for patients with huge tracheal tumor during general anesthesia. Here we reported two cases of extremely huge endotracheal tumors undergoing fiberoptic bronchoscopic interventional therapy under general anesthesia. We hope the experience will be of reference value for formulating reasonable anesthesia scheme for such critically ill patients.Case Description: The two patients were accompanied with severe respiratory distress. And fiberoptic bronchoscopy revealed that the trachea cavity was blocked nearly completely by extremely huge tracheal tumor. Tracheal tumors were scheduled to be removed with fiberoptic bronchoscopic interventional therapy.General anesthesia was inducted with alfentanil and propofol. Then a laryngeal mask was inserted and spontaneous breath was preserved. During the operation, complete airway obstruction occurred, but it was effectively handled by using the fiberoptic bronchoscope to push the tumor and reopen the gap between the mass and the tracheal wall. After the therapy, the patients' symptom of respiratory distress was relieved significantly.Conclusions: For patients with huge tracheal tumor that to be handled with fiberoptic bronchoscopic interventional therapy, general anesthesia with spontaneous breath induced by alfentanil and propofol is preferable. The most important, when complete airway blockade occurs during the process, pushing the tumor and reopening the respiratory tract with fiberoptic bronchoscope is a fairly effective solution to enable patients to be reoxygenated.

Modified Dixon sequential method to determine the effective dose of alfentanil compounded with propofol for day-case hysteroscopy

“…8,9 Referring to the dose of alfentanil required for moderate sedation in previous studies, 10 μg/kg was used for hysteroscopy in this study. 9 In light of the previous hysteroscopy, which used 1.5-2.0 mg/kg propofol alone for anesthesia induction, this study used a combination of 1.5 mg/kg propofol and alfentanil for anesthesia. 25 Patients moved or frowned frequently during hysteroscopy when a score of 2 ⩽ MOAA/S score ⩽ 3.…”

“…Therefore, a MOAA/S score ⩽1 was used as a valid sedation score in this study. 9,[11][12][13] After the hysteroscopy in the 29th instance, there were seven crossover waves of both positive and negative responses. An arithmetic design with seven alfentanil dose groups, including In this study, no adverse effects such as bradycardia, hypotension, nausea, vomiting, dizziness, or headache were observed in any of the 29 patients.…”

“…A single push of 10 μg/kg alfentanil produced analgesia for 7–9 min, which is comparable to the duration of action of propofol. 8,9 Referring to the dose of alfentanil required for moderate sedation in previous studies, 10 μg/kg was used for hysteroscopy in this study. 9 In light of the previous hysteroscopy, which used 1.5–2.0 mg/kg propofol alone for anesthesia induction, this study used a combination of 1.5 mg/kg propofol and alfentanil for anesthesia.…”

“…The initial dose of alfentanil was determined to be 10 μg/kg based on preliminary pretests and previous research literature. 8,9 All patients received more than 30 s of intravenous alfentanil (Yichang Renfu Pharmaceutical Co., Ltd., Yichang, China), followed by 1.5 mg/kg of intravenous propofol (AstraZeneca, London, UK). The modified Dixon sequential method was used to conduct the trial, and the subject's alfentanil dose depended on whether the prior hysteroscopy had failed, which was defined as inadequate cervical dilatation and hysteroscope placement with the patient exhibiting body movement, frowning, or a MOAA/S score >1.…”

“…Alfentanil is a short-acting analgesic, but serious side effects such as respiratory depression and postoperative nausea and vomiting have limited its clinical use. 8,9 The use of compound anesthesia can provide adequate analgesia while reducing opioid consumption and minimizing opioid-related side effects. However, the minimum effective dose of alfentanil for hysteroscopy when combined with propofol is unknown.…”