Tracheostomy and venovenous extracorporeal membrane oxygenation for difficult airway patient with carinal melanoma:A case report and literature review

作     者：I-Liang Liu An-Hsun Chou Chien-Hung Chiu Yu-Ting Cheng Huan-Tang Lin 

作者机构：Department of AnesthesiologyChang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan College of MedicineChang Gung UniversityTaoyuan 333Taiwan Division of Thoracic and Cardiovascular SurgeryDepartment of SurgeryChang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Graduate Institute of Clinical Medical SciencesChang Gung UniversityTaoyuan 333Taiwan 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2022年第10卷第35期

页      面：13088-13098页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 100217[医学-麻醉学] 10[医学] 

主　　题：Tracheostomy Extracorporeal membrane oxygenation Tracheal tumor Melanoma Case report 

摘      要：BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper *** report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation(VV-ECMO)support for rigid bronchoscopy-assisted tumor *** SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope *** computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen *** bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal *** of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby *** to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy *** transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation *** and internal jugular vein were catheterized to facilitate possible VV-ECMO *** tracheostomy,progressive desaturation developed and VV-ECMO was instituted *** tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative *** days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged *** In a difficult airway patient with severe airway obstruction,emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving,and ECMO can be weaned smoothly after tumor *** anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintaine