التفاصيل البيبلوغرافية
| العنوان: |
Anesthesia Management in a Case Undergoing Carina Resection and Tracheobronchial Reconstruction through Left Video-assisted Thoracoscopic Surgery and Right Thoracotomy. |
| المؤلفون: |
Çakar, Nur Sena, Alagöz, Ali, Arıcan, Dilara, Tunç, Mehtap, Fındık, Göktürk, Sazak, Hilal |
| المصدر: |
Journal of Anesthesia / Anestezi Dergisi (JARSS); 2023 Special Issue, Vol. 31, p174-175, 2p |
| مصطلحات موضوعية: |
VIDEO-assisted thoracic surgery, HIGH-frequency ventilation (Therapy), THORACOTOMY, EXTRACORPOREAL membrane oxygenation, SUBCLAVIAN veins, RADIAL artery, INTRAVENOUS anesthesia |
| مستخلص: |
Background: Tracheal and carinal procedures are special operations requiring communication between anesthesia and surgical teams to ensure the safety of airways. Here, we wanted to emphasize anesthesia management on our patient who is undergoing bilateral thoracic surgery and carina resection. Case: A 61-year-old male patient who was planned for carina resection/reconstruction through left video-assisted thoracoscopic surgery (VATS) and right thoracotomy was evaluated as ASA 3. Mechanical tumor resection was performed by interventional pulmonology clinic and partial airway patency was achieved. In thorax computed-tomography, there was a 30x24 mm carinal lesion obstructing both main bronchi. After monitorization, thoracic epidural, radial artery and subclavian vein catheterizations were performed. Total intravenous anesthesia was applied. The patient was intubated with an Univent® tube. Bronchial blocker (BB) was inserted into the left main bronchus using a bronchoscope (Figure1). After left VATS was completed, the BB was placed in the right main bronchus (Figure 2) and right thoracotomy was started. During incision on the right bronchus, BB and Univent® were pulled proximally in the trachea and ventilation was interrupted (Figure 2). An endotracheal tube (ETT) was placed in the right intermediate bronchus from surgical field, "cross-field ventilation" was started with a sterile connection. Then the trachea and the left main bronchus incisions was made and carina resected (Figure3). ETT was placed in distal part of incision in the left bronchus, a catheter for high frequency jet ventilation(HFJV) was placed in the right intermediate bronchus. Right/left lungs were ventilated alternately with ETT/HFJV during suturing(Figure 4). Arterial blood gas values were stable. The patient was transferred to Intensive Care Unit after electively intubated. At postoperative 48th hour, extubation was achieved. We do not have any conflict of interest. This report has not been published before. Written informed consent was obtained from the patient. Conclusion: Studies on tracheobronchial surgeries and specific anesthesia applications are limited and quite complicated. "Cross-field" ventilation and/or HFJV are frequently used techniques. We have used these methods successfully. In recent years, flow-controlled ventilation has started to be accepted in such cases. In ideal conditions, extracorporeal membrane oxygenation should be available for crisis moments. Carinal resections and reconstructions are challenging procedures in terms of airway managements. Close follow-up, preparation and interdisciplinary cooperation in perioperative period is a key point in terms of patient safety. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
