Peripheral Cardiopulmonary Bypass in Two Patients With Symptomatic Tracheal Masses: Perioperative Challenges

Misra, Satyajeet; Behera, Bikram Kishore; Preetam, Chappity; Mohanty, Shruti; Mahapatra, Rudra Pratap; Tapuria, Priyank; Elayat, Anirudh; Nayak, Anindya; Kotkar, Kunal; McNeil, John S.; Blank, Randal S.

doi:10.1053/j.jvca.2020.11.041

Cited by 5 publications

(39 citation statements)

References 44 publications

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“…It allows for complete heart emptying, ensuring that only the CPB circuit pumps all the cardiac output. 7 Harlequin syndrome develops when native left ventricular (LV) function is preserved or is recovering while the lungs' function is still poor (e.g., in respiratory failure) or mechanical ventilation is temporarily paused. [22][23][24]27 If peripheral femorofemoral VA ECMO is instituted in cardiogenic shock patients, oxygenated blood will be delivered mainly retrograde up to the aortic root by the arterial cannula in the common femoral artery.…”

Section: Discussionmentioning

confidence: 99%

“…This results in coronaries and carotid arteries being perfused with deoxygenated blood, which leads to heart and brain hypoxia. 7 This is characterised by normal oxygen saturations in the lower body and low oxygen saturations in the upper body. A right radial artery catheter can reliably determine the location of the watershed zone being distal or proximal to the brachiocephalic artery for adequacy of brain oxygenation by serving as a sampling site for arterial blood gas values.…”

Section: Discussionmentioning

confidence: 99%

“…22 Another possible way to ameliorate Harlequin syndrome was to convert to central arterial cannulation of the right axillary artery or ascending aorta, in order for oxygenated blood to be pumped directly into the aortic arch and aortic root. 7 However, this requires surgical exposure of right axillary artery for direct cannulation or performing a sternotomy, respectively. In our patient, the safest and quickest approach to correct Harlequin syndrome was endotracheal intubation and lung ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…This approach is successfully used in patients requiring VV ECMO support but have no IJV access. 7 Another approach for VV ECMO support would be to insert a dual-lumen cannula in the right IJV, under uoroscopy or TEE guidance. 7 All these approaches are safe and excellent for oxygenation support in such cases.…”

Section: Discussionmentioning

confidence: 99%

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Harlequin Syndrome during Peripheral Cardiopulmonary Bypass in a Patient with an Obstructing Tracheal Schwannoma: A Case Report

Karam

Nafeh

Aouad

et al. 2023

Preprint

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Harlequin Syndrome during Peripheral Cardiopulmonary Bypass in a Patient with an Obstructing Tracheal Schwannoma: A Case Report

Karam

Nafeh

Aouad

et al. 2023

Preprint

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“…Alfentanil and propofol induced anesthesia for patients with huge endotracheal tumor undergoing fiberoptic bronchoscopic interventional therapy: case report Therefore, the technique of extracorporeal membrane oxygenation (ECMO) is recommended to ensure the safe performance of anesthesia and surgery for such patients (1,2). However, an ECMO team is not always available in some hospitals.…”

Section: Case Reportmentioning

confidence: 99%

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

Zhu¹,

Sun²,

Wang³

et al. 2022

Transl Cancer Res TCR

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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.

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Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report

Karam

Nafeh

Aouad

et al. 2023

Clinical Case Reports

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Surgical resection of obstructive tracheal tumors can be challenging to cardiothoracic surgeons and anesthesiologists. It is often difficult in these cases to maintain oxygenation by face mask ventilation during induction of general anesthesia. Also, the extent and location of these tracheal tumors can preclude conventional induction of general anesthesia and subsequent successful endotracheal intubation. Peripheral cardiopulmonary bypass (CPB) under local anesthesia and mild intravenous sedation may be safe to support the patient until securing a definitive airway. We describe a case of a 19-year-old female with a tracheal schwannoma, who developed differential hypoxemia (Harlequin, or North-South, syndrome) after institution of awake peripheral femorofemoral venoarterial (VA) partial CBP. K E Y W O R D S differential hypoxemia, femorofemoral cardiopulmonary bypass (CPB), harlequin syndrome, north-south syndrome, venoarterial (VA) extracorporeal membrane oxygenation (ECMO), venovenous (VV) extracorporeal membrane oxygenation (ECMO) How to cite this article: Karam C, Nafeh NA, Aouad MT, et al. Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report.

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Peripheral Cardiopulmonary Bypass in Two Patients With Symptomatic Tracheal Masses: Perioperative Challenges

Cited by 5 publications

References 44 publications

Harlequin Syndrome during Peripheral Cardiopulmonary Bypass in a Patient with an Obstructing Tracheal Schwannoma: A Case Report

Harlequin Syndrome during Peripheral Cardiopulmonary Bypass in a Patient with an Obstructing Tracheal Schwannoma: A Case Report

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

Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report

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