Femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia in the management of upper airway obstruction

Jensen, V.; Milne, Brian; Salerno, Tomás A.

doi:10.1007/bf03013806

Cited by 21 publications

(13 citation statements)

References 6 publications

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“…The management of lower tracheal obstructions have included PEEP and posture changes [19], low-frequency jet ventilation [20], helium-oxygen mixtures [21] and cardiopulmonary bypass [22]. Most of the experience has been gained from anaesthesia for mediastinal tumours and retrosternal goitres.…”

Section: Discussionmentioning

confidence: 99%

“…Akhtar et al [19] reported a case of a 5-year-old child who was found to have a large anterior mediastinal tumour compressing the trachea and bronchi after a choking episode having inhaled a foreign body. Jensen et al [22] used femorofemoral cardiopulmonary bypass prior to induction of anaesthesia in a patient with impending airway obstruction due to a squamous cell carcinoma. Caution is needed with the use of PEEP because this may worsen air trapping, as occurred with our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the experience has been gained from anaesthesia for mediastinal tumours and retrosternal goitres. The management of lower tracheal obstructions have included PEEP and posture changes [19], low-frequency jet ventilation [20], helium-oxygen mixtures [21] and cardiopulmonary bypass [22]. Akhtar et al [19] reported a case of a 5-year-old child who was found to have a large anterior mediastinal tumour compressing the trachea and bronchi after a choking episode having inhaled a foreign body.…”

Section: Discussionmentioning

confidence: 99%

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Anterior mediastinal masses: an anaesthetic challenge

Goh¹,

1999

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SummaryA patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed tomographic scan demonstrated narrowing of the distal trachea, and right and left main stem bronchi. An awake intubation was done. Thiopentone and muscle relaxant were given and surgery commenced. High airway pressure developed and ventilation became difficult, although oxygenation remained satisfactory throughout. Anaesthetic implications are discussed. We recommend that patients with more than 50% obstruction of the airway at the level of the lower trachea and main bronchi have their femoral vessels cannulated in readiness for cardiopulmonary bypass. Anterior mediastinal masses are uncommon, but when they present at surgery for diagnostic or for definitive procedures, they pose serious challenges for the anaesthetist. By nature of their anatomical location, they produce three problems: compression of the heart, compression of the large vessels (principally the superior vena cava) and compression of the trachea and main bronchi. Compression of the airway can be insidious when it is intrathoracic and at the bronchial level. Thus, a patient can be asymptomatic and yet have airway compression which only manifests at induction of anaesthesia when voluntary control of the airway is lost. The anaesthetist who is unprepared will face a catastrophic situation of total obstruction of the airway leading to death of the patient.We report a case of a massive anterior mediastinal mass causing intrathoracic airway obstruction during which some anaesthetic problems arose. We also reviewed the literature and, in the light of this, present our recommendations for the management of patients with such masses. Case historyA 20-year-old Malay woman presented for a diagnostic biopsy of an anterior mediastinal mass. She had a history of a cough for one month. There was no history of dyspnoea, stridor or noisy breathing. Chest X-ray showed a massive mediastinal mass filling more than two-thirds of the chest (Figs 1 and 2) and a computed tomographic scan confirmed this finding as well as compression of both main bronchi (Figs 3 and 4).An awake intubation was done with fentanyl 100 mg, and topical anaesthesia of the oropharynx. A size 7 tracheal tube was inserted easily past the cords. Bilateral breath sounds were ascertained and the tracheal tube secured. Initial manual ventilation showed no increase in peak airway pressures. Thiopentone and atracurium were administered, anaesthesia was maintained with isoflurane and surgery commenced. It was then noticed that the peak airway pressure had increased to 50 cmH 2 O. Auscultation of the lungs revealed coarse rhonchi in both inspiration and expiration. Treatment was instituted for what was diagnosed as bronchospasm, with salbutamol given through the breathing system. There was no change in the lung sounds. Paper 961 670ᮊ 1999 Blackwell Science Ltd biopsy. A frozen section revealed a lymphoma and surgery was terminated. Mu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anterior mediastinal masses: an anaesthetic challenge

Goh¹,

1999

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“…While some lesions may be managed by rigid bronchoscopy and debridement with intermittent ventilation; extensive tracheal obstruction, need for prolonged debridement and significant bleeding into the airway present formidable problems. Historically full CPB support was instituted via femoral venous and arterial catheters placed under local anesthesia (14). More recently, VV-ECMO support has been reported for endotracheal tumor resection (15,16), dislodged stents (15,17), foreign body removal (18), control of hemoptysis (19), debridement of papillomatosis (20) and relief of external compression (15,21,22) in adults.…”

Section: Airway Surgerymentioning

confidence: 99%

Principles and indications of extracorporeal life support in general thoracic surgery

McRae¹,

Perrot²

2018

J. Thorac. Dis.

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The role of extracorporeal life support (ECLS) has expanded rapidly over the past 15 years to become an important tool in advanced general thoracic surgery practice. Intra-operative and in some cases continued post-operative ECLS is redefining the scope of complex surgical care. ECLS encompasses a spectrum of temporary mechanical support that may remove CO 2 , oxygenate or provide hemodynamic support or a combination thereof. The most common modalities used in general thoracic surgery include extracorporeal membrane oxygenation (ECMO), interventional lung assist device (iLA ® Novalung ® , Heilbronn, Germany), and extracorporeal CO 2 removal (ECCO 2 R). The ECMO and Novalung ® devices can be used in different modes for the short term or long-term support depending on the situation. In this review, the principles and current applications of ECLS in general thoracic surgery are presented.

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“…The published experience is extensive for the use of ECLS support during complex endoscopic airway interventions. Although the use of CPB with full heparinization has been anecdotally reported, ECMO should be used as the device of choice (50,58). V-a ECMO is favored in the acute setting of a patient who is hemodynamically unstable (16), but for all other interventions v-v ECMO is preferred (7,25,27).…”

Section: Ecls As a Support For Endoscopic Interventionsmentioning

confidence: 99%

Extracorporeal support in airway surgery

Höetzenecker¹,

Klepetko²,

Keshavjee³

et al. 2017

J. Thorac. Dis.

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Extracorporeal life support (ECLS) is increasingly used for major airway surgery. It facilitates complex reconstructions and maintains gas exchange during endoscopic procedures in patients with critical airway obstruction. ECLS offers the advantage of an uncluttered surgical field and eliminates the need for crossing ventilation tubes, thus, making precise surgical dissection easier. ECLS is currently used for hemodynamic and respiratory support in lung transplantation as well as extended tumor resections with an acceptable risk profile. This work reviews the published experience of ECLS in airway surgery both in adults and in pediatric patients. It highlights currently available devices and their indications.

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Femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia in the management of upper airway obstruction

Abstract: Femoral

Cited by 21 publications

References 6 publications

Anterior mediastinal masses: an anaesthetic challenge

Anterior mediastinal masses: an anaesthetic challenge

Principles and indications of extracorporeal life support in general thoracic surgery

Extracorporeal support in airway surgery

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