Mediastinal mass resection: Femorofemoral cardiopulmonary bypass before induction of anesthesia in the management of airway obstruction

Tempe, Deepak K; Arya, Rajesh; Dubey, Sandeep; Khanna, Sangeeta; Tomar, A. S.; Grover, Vijay; Nigam, M; Makwane, U. K.

doi:10.1053/jcan.2001.21988

Cited by 62 publications

(33 citation statements)

References 18 publications

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“…[4] Lokal anestezi altında gerçekleştirilen ekstrakorporeal sirkülasyon, günümüzde trakeal ve mediastinal tümör-lerin neden olduğu havayolu tıkanıklığı, trakeal laserasyon ve rüptür, komplet trakea kesisi, komplike olmuş trakeal stentlerin çıkarılması sırasında ve havayolunu tamamen tıkayıcı yabancı cisim varlığı gibi durumlarda kullanılmış sıra dışı bir havayolu yönetimi yaklaşımı-dır. [5][6][7][8] Ekstrakorporeal dolaşım; trakea cerrahisi gibi non-kardiyak cerrahilerde kardiyopulmoner fonksiyonları desteklemek için kullanılabilir ve trakea tamamen tıkanmış olsa bile gaz değişimini sağlar. [9] Adwan ve ark.…”

Section: Discussionunclassified

Tracheal stent implantation with extracorporeal circulation

Erden¹

2014

Turk Gogus Kalp Dama

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Trakeal darlığı olan hastaların anestezi sırasındaki oksijenasyonu entübasyon ya da trakeotomi gibi klasik birçok yolla sağlanabilirken, ekstrakorporeal sirkülasyon nadir uygulanan sıra dışı bir yöntemdir. Yoğun bakım ünitemize solunum sıkıntısı ile kabul edilen, Amerikan Anesteziyoloji Derneği (ASA) skoru IVE olan 73 yaşında erkek hastada krikoid kıkırdağın alt sınırından karinanın 5 cm üzerine kadar 6 cm'lik segmentte, trakeayı ve vasküler yapıları çevreleyen, en dar yerinde 1 mm çaplı açıklığa neden olan nonrezektabl malign eksternal kitle vardı. Lezyon yeri ve yapısı nedeniyle rutin yöntemlerle havayolu güvenliği sağla-namayacak olan hastanın daralmış trakea segmentine stent yerleştirilmesine ve işlemin ekstrakorporeal sirkülasyon ile oksijenizasyon altında yapılmasına karar verildi. Uygun hazırlığın ardından ameliyat odasına alınarak monitörize edilen hastaya intravenöz fentanil ve propofol infüzyonu başlatıldı. Lokal anestezi altında femoral arter ve ven kanüle edildi. Heparinizasyon sonrası ekstrakorporeal sirkülasyon ile oksijenizasyon sağlandı. Trakeal lezyona rijit bronkoskopi ve skopi eşliğinde stentler yerleştirildi. İşlem sonrası hasta entübe edildi ve ekstrakorporeal dolaşım sonlandırıldı. Hasta sedasyon altında yoğun bakım ünite-sinde izleme alındı. Ertesi sabah ekstübe edildi. Hastamızda zor havayolu açısından tam bir ameliyat öncesi hazırlığı gerektiren stent uygulaması, multidisipliner bir yaklaşımla başarılı bir şekilde uygulanabildi. Havayolu cerrahisi anestezisi sırasında ekstrakorporeal sirkülasyon uygulaması ile oksijenasyon, hayat kurtarıcı bir stratejidir.Anah tar söz cük ler: Havayolu tıkanıklığı; anestezi; kardiyopulmoner baypas; ekstrakorporeal dolaşım; trakeal darlık.Oxygenation of the patients with tracheal stenosis under anesthesia can be provided by many traditional techniques such as intubation or tracheotomy, while extracorporeal circulation is an unusal method. A 73-year-old male patient in American Society of Anesthesiologists (ASA) score IVE was admitted to intensive care unit for respiratory distress and a nonresectable malignant external mass, from lower border of the cricoid cartilage up to 5 cm above the carina of 6 cm segment, surrounding vascular structures and trachea, leading to 1 mm diameter patency in the narrowest part, was present. Due to the location and structure of the lesion, safety of airway of the patient would not be provided by routine methods, hence, a stent was decided to be placed on stenotic segment of the trachea under oxygenation with extracorporeal circulation. Following appropriate preparation, patient was monitored in the operating room, and intravenous fentanyl and propofol infusion was started. Femoral artery and vein was cannulated under local anesthesia. After heparinization, oxygenation was achieved by extracorporeal circulation. Stents were placed using rigid bronchoscopy and fluoroscopy on tracheal lesion. After the procedure, the patient was intubated and extracorporeal circulation was terminated. The patient was monitored under sedation i...

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Section: Discussionunclassified

Tracheal stent implantation with extracorporeal circulation

Erden¹

2014

Turk Gogus Kalp Dama

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“…However, some have noted that even having bypass equipment on stand-by will not always ensure a good outcome [9]. Even with a bypass team on standby, it may take from 5 to 10 min for adequate oxygenation to be achieved after complete airway obstruction [18]. Although the patient is most likely to be resuscitated, there is a good chance of hypoxic neurological injury.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for anesthetic management of anterior mediastinal mass

et al. 2010

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Anesthetic management of anterior mediastinal masses (AMM) is challenging. We describe the successful anesthetic management of two patients with AMM in which dexmedetomidine was used at supra-sedative doses. Our first case was a 41-year-old man who presented with a 10 x 9 x 11 cm AMM, a pericardial effusion, compression of the right atrium, and superior vena cava syndrome. He had severe obstruction of the right mainstem bronchus, distal trachea with tumor compression, and endobronchial tumor invasion. Our second case was a 62-year-old man with tracheal and bronchial obstruction secondary to a recurrent non-small-cell lung cancer mediastinal mass. Both patients were scheduled for laser tumor debulking and treatment of the tracheal compression with a Y-stent placed through a rigid bronchoscope. Both patients were fiberoptically intubated awake under sedation using a dexmedetomidine infusion, followed by general anesthesia (mainly using higher doses of dexmedetomidine), thus maintaining spontaneous ventilation and avoiding muscle relaxation during a very stimulating procedure. The amnestic and analgesic properties of dexmedetomidine were particularly helpful. Maintaining spontaneous ventilation with dexmedetomidine as almost the sole anesthetic could be very advantageous and may reduce the risk of complete airway obstruction in the anesthetic management of AMMs.

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“…This is a particular risk for children with large anterior lymphomas. Historically this has been treated with CPB support (45,46). More recently, pre-induction femoral VA-ECMO while maintaining spontaneous ventilation has been described in children (47) and adults (48).…”

Section: Mediastinal Massesmentioning

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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Mediastinal mass resection: Femorofemoral cardiopulmonary bypass before induction of anesthesia in the management of airway obstruction

Cited by 62 publications

References 18 publications

Tracheal stent implantation with extracorporeal circulation

Tracheal stent implantation with extracorporeal circulation

Dexmedetomidine for anesthetic management of anterior mediastinal mass

Principles and indications of extracorporeal life support in general thoracic surgery

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