Management of a tumor in the distal trachea while maintaining spontaneous ventilation

Abstract

A 50-year-old man with carcinoma of the trachea presented for debulking. Due to the distal location of the tumor, a tracheostomy was not feasible. We were asked to provide general anesthesia but to maintain spontaneous ventilation. Sedation was provided with dexmedetomidine 0.7 μg/kg per hour. Following induction with ketamine 2 mg/kg, the trachea was sprayed with 5 ml of 4% lidocaine and, with assistance from the surgeon, a Cook™ Airway Exchange catheter was placed with the distal end just beyond the tumor. We then connected the proximal end to a manual jet ventilator to provide oxygen supplementation and, if necessary, positive-pressure ventilation. Subsequently, the surgeons were able to completely debulk the tumor and examine the airway down to the carina. Spontaneous ventilation was maintained throughout the case, with additional boluses of ketamine as necessary. The patient woke up after the procedure and had no delirium, nightmares, or recall. Dexmedetomidine worked synergistically with ketamine by preventing hypertension, hypersecretion, and postoperative delirium that is often seen when using ketamine alone. The successful use of ketamine and dexmedetomidine in this case demonstrates that this method may be applicable to other clinical situations where deep sedation and maintenance of spontaneous ventilation is required.

Two Phase Modulation of NH4+ Entry and Cl−/HCO3- Exchanger in Submandibular Glands Cells by Dexmedetomidine

“…To address this question, we measured ductal fluid secretion using the sealed parotid ductal ex vivo system. Interestingly, in contrast to the hyposecretion effect observed clinically (Marks et al, 2010 ), Dex increased forskolin-stimulated parotid ductal fluid secretion (Figure 1G ). Dex-stimulated fluid secretion at 40 min was 33.5 ± 11.2% higher than in the control (Figure 1H ).…”

“…Previously, we demonstrated that Dex attenuated histamine-induced Ca 2+ increase and IL-6 expression in human salivary glands (HSG) cells (Yang and Hong, 2015 ). Although, Dex reduces inflammation, there are side effects associated with it, such as reduced salivary secretion (Karhuvaara et al, 1991 ; Bischoff and Kochs, 1993 ) and prevented hypersecretion (Marks et al, 2010 ). Monoxidine, a α2-adrenoceptor and imidazole agonist, mediates salivary glands vasoconstriction leading to hyposalivation (Moreira et al, 2013 ).…”

Sudden Tracheal Collapse during EGD and Subsequent Anesthetic Management with Dexmedetomidine-Ketamine in a Patient with Achalasia and Tracheomalacia

“…The combination of ketamine and racemic medetomidine is employed extensively for large animal surgery. A few recent literature reports describe the effective use of a ketamine-dexmedetomidine combination for procedural sedation [14–16]. …”

Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy

“…These tumors are commonly discovered during a health checkup or diagnosed when a patient experiences coughing, hemoptysis, or breathing difficulties [2,3]. Although several reports describe anesthesia for patients with airway stenosis due to tracheal tumors [4][5][6], there have been few reports describing anesthesia in patients with a tracheal hemangioma characterized by bleeding tendency [7][8][9][10]. Here we report anesthesia in a patient with primary tracheal hemangiomas who underwent lung lobectomy, with one-lung ventilation.…”