Anesthetic Management of Tracheectomy in a Patient with End-stage Dilated Cardiomyopathy Whose Respiratory Distress was Caused by Subglottic Tracheal Stenosis

Abstract

［Introduction］We report a case of subglottic stenosis as a cause of respiratory distress in a patient with end-stage idiopathic dilated cardiomyopathy.［Case presentation］A 41-year-old man was diagnosed with severe tracheal stenosis on imaging examination for heart failure and underwent tracheectomy of the stenosis. Before inducing anesthesia, a veno-arterial extracorporeal membrane oxygenator (VA-ECMO) and intra-aortic balloon pump (IABP) were attached, and the airway was secured with a supraglottic device (SGA) . After the resection at the distal site of tracheal stenosis, operative field intubation was performed. After excision of the stricture, tracheal anastomosis was performed, and oral intubation was switched to complete as planned. Intraoperative SGA controlled breathing had become impossible, but hypoxia and hypercapnia did not occur. The patient's symptoms improved postoperatively. ［Conclusion］We performed anesthesia for tracheectomy in a patient with hypocardiac function in which respiratory distress was caused by subglottic tracheal stenosis. Using SGA, VA-ECMO and IABP, the operation could be completed while maintaining stable respiration and circulation.