巨大前纵隔肿瘤切除术中上腔静脉置换的特殊气道管理

Specific airway management for SVC replacement during giant anterior mediastinal tumor resection.

作者信息

Kawagoe Izumi, Satoh Daizoh, Mitaka Chieko, Fukuda Masataka, Kochiyama Tsukasa, Hayashida Masakazu

机构信息

Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.

出版信息

JA Clin Rep. 2020 Sep 14;6(1):70. doi: 10.1186/s40981-020-00377-w.

DOI:10.1186/s40981-020-00377-w

PMID:32929663

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7490311/

Abstract

BACKGROUND

Giant anterior mediastinal tumor (GAMT) resection is a challenging procedure, for which anesthesiologist might take to need special precautions.

CASE PRESENTATION

A 48-year-old male patient had been scheduled to undergo GAMT resection and superior vena cava (SVC) replacement. The tumor spread surrounding SVC and left main bronchus (LMB), resulting in small volume of his left lung. A soft left-sided double lumen tube (DLT) was selected to keep the patency of LMB during left one lung ventilation (OLV) against the tumor weight. Semi-awake intubation with spontaneous breathing was selected for DLT insertion to avoid lower airway occlusion. During left OLV after right open thoracotomy, his SPO decreased below to 90%. We performed selective right upper lobe bronchial blockade using the combination of DLT and bronchial blocker. The surgery was successfully completed with this strategy.

CONCLUSIONS

Although such cases are rare, they are informative for anesthesiologists, providing optional strategies.

摘要

背景

巨大前纵隔肿瘤（GAMT）切除术是一项具有挑战性的手术，麻醉医生可能需要采取特殊预防措施。

病例介绍

一名48岁男性患者计划接受GAMT切除术和上腔静脉（SVC）置换术。肿瘤蔓延至SVC和左主支气管（LMB）周围，导致其左肺体积减小。选择左侧柔软双腔支气管导管（DLT），以便在左侧单肺通气（OLV）期间对抗肿瘤重量保持LMB通畅。选择在自主呼吸下进行半清醒插管以插入DLT，避免下气道阻塞。右胸开胸后进行左侧OLV期间，其血氧饱和度（SPO）降至90%以下。我们联合使用DLT和支气管封堵器进行选择性右上叶支气管封堵。采用该策略手术成功完成。