Critical airway obstruction during general anaesthesia caused by anterior mediastinal mass managed by ECMO and tracheobronchial stenting


Authors: K. Netri 1;  J. Votruba 2;  J. Rulíšek 1;  L. Kraus 1;  P. Michálek 1,3
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny 1. LF UK a Všeobecné fakultní nemocnice, Praha 1;  První klinika tuberkulózy a respiračních nemocí 1. LF UK a Všeobecné fakultní nemocnice, Praha 2;  Department of Anaesthetics, Antrim Area Hospital, Antrim, Spojené království Velké Británie a Severního Irska 3
Published in: Anest. intenziv. Med., 27, 2016, č. 6, s. 390-394
Category:

Overview

Acute compression of the trachea and the large bronchi during anaesthesia can very quickly lead to development of life-threatening hypoxia, if alternative methods of oxygenation are not established immediately. The case report describes the course and management of a sudden collapse of the lower part of the trachea and main bronchi in a young patient who was indicated for the extirpation of deep cervical lymph nodes under general anesthesia. He developed very high inspiratory pressures with a significant reduction in lung volumes and desaturation, which was caused by compression of the airway due to a lymphoma mass in the anterior mediastinum. In order to improve oxygenation, a suction catheter was inserted endobronchially and the patient was ventilated through it. He was then connected to the ECMO device and definitive solution of the stenosis was achieved with a “Y” stent inserted into the trachea. Three years after the procedure, the underlying disease is in remission and the patient is in good health.

Keywords:
anterior mediastinal mass – tracheal obstruction – extracorporeal membrane oxygenation (ECMO) – stenting


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Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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