Anesthetic Airway Management of Severe Airway Stenosis Due to Thyroid Carcinoma

DOI 3 Citations 9 References
  • KOJIMA Mikiko
    Department of Anesthesiology, Showa University School of Medicine
  • MARUI Terumi
    Department of Anesthesiology, Showa University School of Medicine
  • TAKEMOTO Mariko
    Department of Anesthesiology, Showa University School of Medicine
  • HIRAMATSU Runa
    Department of Anesthesiology, Showa University School of Medicine
  • OKU Kazunori
    Department of Anesthesiology, Showa University School of Medicine
  • OHTAKI Reiko
    Department of Anesthesiology, Showa University School of Medicine

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Other Title
  • 甲状腺癌の喉頭浸潤による気道狭窄症例の麻酔経験

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Abstract

  We present the case of a 50-year-old female with severe dyspnea caused by advanced invasive thyroid carcinoma. Total thyroidectomy, laryngectomy, and neck dissection under general anesthesia were scheduled; however, airway management proved problematic. Cervical CT revealed the minimum tracheal cross-section as reduced to ≤40% of normal. Because nasal fiberoptic tracheal intubation proved impossible due to invasive tumorous tissue obstructing the glottis, we initiated percutaneous cardiopulmonary support (PCPS). Cannulation was performed via the femoral vein and artery under local anesthesia; remifentanil was administered during cannulation. Oxygenation became satisfactory following initiation of PCPS. We then induced general anesthesia with propofol-remifentanil, and tracheostomy was performed under PCPS. The patient began ventilating artificially via a Montandon tube, and was smoothly weaned from the extracorporeal circulation by PCPS. No surgical complications occurred. The postoperative course was uneventful, and she was discharged after 26 days. The prompt initiation of PCPS enabled safe anesthetic management in this case of severe airway stenosis.

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