[Placement of self-expanding metallic stents in the stenotic trachea and bronchus under the support of gas exchange by extracorporeal lung assist (ECLA)].

Three self-expanding metallic stents (MS) were placed in a patient with severe dyspnea due to tracheo-bronchial stenosis caused by a large metastatic malignant tumor. To ensure adequate gas exchange, we used ECLA during surgery. After ECLA was started with V-V bypass (blood flow 1.3 l.min-1, 100% O2 flow 10 l.min-1), the patient was administered droperidol and fentanyl, and orotracheally intubated with an endotracheal tube (7.0 mm ID) using a bronchofiberscope. Anesthesia was maintained with midazolam, but no neuromuscular blocking agent was used. The pulmonary ventilation was withheld 3 times during each period of 5-10 min for MS placement through the endotracheal tube. The patient was ventilated for a few min between each procedure. Values of arterial blood gas were maintained within physiological ranges throughout the surgery. ECLA was a useful means of ensuring adequate gas exchange in perioperative patients with difficult airway.