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Extracorporeal membrane oxygenation for the anesthetic management of a patient with severe airway stenosis caused by thyroid carcinoma invasion

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Abstract

The treatment of a thyroid carcinoma extending into the thoracic cavity with severe airway stenosis is difficult, since there is a risk of acute respiratory decompensation at every stage of anesthesia. Extracorporeal membrane oxygenation (ECMO) is a life support technique for maintaining both the cardiac and respiratory functions. It is used for the management of acute, severe, reversible respiratory or cardiac failure refractory to conventional management. We herein describe the use of ECMO for the anesthetic management of an elderly patient with severe airway stenosis caused by thyroid carcinoma invasion, which underwent total thyroidectomy with the resection of four tracheal rings and end-to-end anastomosis under a median sternotomy. Although the risks and benefits should be carefully weighed before a decision to use ECMO is made, the use of ECMO in the management of general anesthesia may be a rational and effective strategy for maintaining oxygenation.

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References

  1. Mason RA, Fielder CP. The obstructed airway in head and neck surgery. Anaesthesia. 1999;54:625–8.

    Article  CAS  Google Scholar 

  2. Takeda S, Miyoshi S, Omori K, Okumura M, Matsuda H. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor. Ann Thorac Surg. 1999;68:2324–6.

    Article  CAS  Google Scholar 

  3. Goh MH, Liu XY, Goh YS. Anterior mediastinal masses: an anaesthetic challenge. Anaesthesia. 1999;54:670–4.

    Article  CAS  Google Scholar 

  4. Allen S, Holena D, McCunn M, Kohl B, Sarani B. A review of the fundamental principles and evidence base in the use of extracorporeal membrane oxygenation (ECMO) in critically ill adult patients. J Intensive Care Med. 2011;26(1):13–26.

    Article  Google Scholar 

  5. Jeong YIl, Jun IG, Ha SS, Kwon HJ, Lee YM. Extracorporeal membrane oxygenation for the anesthetic management of a patient with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms: a case report. Medicine (Baltimore). 2019;98(42):e17650. https://doi.org/10.1097/MD.0000000000017650.

    Article  Google Scholar 

  6. Jayaraman AL, Cormican D, Shah P, Ramakrishna H. Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: techniques, limitations, and special considerations. Ann Card Anaesth. 2017;20(Suppl 1):S11–8.

    Article  Google Scholar 

  7. Combes A, Schmidt M, Hodgson CL, Fan E, Ferguson ND, Fraser JF, et al. Extracorporeal life support for adults with acute respiratory distress syndrome. Intensive Care Med. 2020;2:1–13.

    Google Scholar 

  8. Bittar D. Respiratory obstruction associated with induction of general anesthesia in a patient with mediastinal Hodgkin’s disease. Anesth Analg. 1975;54:399–403.

    Article  CAS  Google Scholar 

  9. Pullerits J, Holzman R. Anaesthesia for patients with mediastinal masses. Can J Anaesth. 1989;36:681–8.

    Article  CAS  Google Scholar 

  10. Lafç G, Budak AB, Yener AÜ, Cicek OF. Use of extracorporeal membrane oxygenation in adults. Heart Lung Circ. 2014;23(1):10–23.

    Article  Google Scholar 

  11. Kim CW, Kim DH, Son BS, Cho JS, Kim YD, Hoseok I, et al. The feasibility of extracorporeal membrane oxygenation in the variant airway problems. Ann Thorac Cardiovasc Surg. 2015;21(6):517–22.

    Article  Google Scholar 

  12. Bechard P, Letourneau L, Lacasse Y, Lacasse Y, Cote D, Bussieres S. Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors. Anesthesiology. 2004;100(4):826–34.

    Article  Google Scholar 

  13. Erdos G, Tzanova I. Perioperative anaesthetic management of mediastinal mass in adults. Eur J Anaesthesiol. 2009;26:627–32.

    Article  Google Scholar 

  14. Ventetuolo CE, Muratore CS. Extracorporeal life support in critically Ill adults. Am J Respir Crit Care Med. 2014;190(5):497–508.

    Article  Google Scholar 

  15. Shekar K, Badulak J, Peek G, Boeken U, Dalton HJ, Arora L, Zakhary B, Ramanathan K, et al. Extracorporeal life support organization coronavirus disease interim guidelines: a consensus document from an international group of interdisciplinary extracorporeal membrane oxygenation providers. ASAIO J. 2020. https://doi.org/10.1097/MAT.0000000000001193.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Stark K, Joskowiak D, Czermak T, Born F, Kupka D, Scherer C, et al. Update on weaning from veno-arterial extracorporeal membrane oxygenation. J Clin Med. 2020;9(4):992. https://doi.org/10.3390/jcm9040992.

    Article  CAS  PubMed Central  Google Scholar 

  17. Donker DW, Brodie D, Henriques JPS, Broomé M. Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions. Perfusion. 2019;34(2):98–105.

    Article  Google Scholar 

  18. Donker DW, Brodie D, Henriques JPS, Broomé M. Left ventricular unloading during veno-arterial ECMO: a simulation study. ASAIO J. 2019;65(1):11–20.

    Article  Google Scholar 

  19. Lee JH, Lee JH, Lee MH, Cho HO, Park SE. Postoperative negative pressure pulmonary edema following repetitive laryngospasm even after reversal of neuromuscular blockade by sugammadex: a case report. Korean J Anesthesiol. 2017;70(1):95–9.

    Article  Google Scholar 

  20. Pluijms WA, van Mook WNKA, Wittekamp BHJ, Bergmans DC. Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review. Crit Care. 2015;19(1):295. https://doi.org/10.1186/s13054-015-1018-2.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fremont RD, Kallet RH, Matthay MA, Ware LB. Postobstructive pulmonary edema: a case for hydrostatic mechanisms. Chest. 2007;131(6):1742–6.

    Article  Google Scholar 

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Correspondence to Yoshifumi Ikeda.

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Yoshifumi Ikeda and the other co-authors have no conflicts of interest to declare.

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Ikeda, Y., Saito, Y., Kadomura, T. et al. Extracorporeal membrane oxygenation for the anesthetic management of a patient with severe airway stenosis caused by thyroid carcinoma invasion. Surg Today 51, 2000–2005 (2021). https://doi.org/10.1007/s00595-021-02331-4

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  • DOI: https://doi.org/10.1007/s00595-021-02331-4

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