Anesthetic Management of Severe Tracheal Stenosis Using Percutaneous Cardiopulmonary Support

Abstract

  We experienced the anesthetic management of balloon expansion in a 70-year-old woman with tracheal stenosis caused by tuberculosis. The stenotic lesion extended from the upper trachea to the carina. Based upon a CT scan, the minimum tracheal diameter was 4.8 mm and intubation through the stenotic lesion was considered to be impossible. Balloon dilation and tracheal stent placement were planned. When a balloon is expanded, the trachea becomes totally obstructed. In this case, the stenotic lesion was long and multiple trials of balloon expansion were required. Since the duration of apnea would be long, we decided to use percutaneous cardiopulmonary support (PCPS) for gas exchange. During the PCPS catheter insertion, the patient was well-sedated with dexmedetomidine and breathed spontaneously. Total intravenous anesthesia was performed after the start of PCPS. There were no problems with oxygenation and circulation under PCPS. After balloon dilation, we decided to continue artificial ventilation for a few days because bleeding and edema were observed within the trachea. We intubated a microlaryngeal tube (ID 6 mm) through the stenotic lesion. The tip of the tube was placed just above the carina. We began artificial ventilation and terminated the PCPS. Three days later, tracheal stents were placed under dexmedetomidine infusion and local anesthesia.