Korean J Anesthesiol.  2004 Feb;46(2):236-240. 10.4097/kjae.2004.46.2.236.

Femorofemoral Cardiopulmonary Bypass in the Management of Severe Airway Obstruction by Thyroid Cancer: A Case Report

• Kwon JY
• Lee HJ
• Kim HK
• Baik SW

• KMID: 2039727
• DOI: http://doi.org/10.4097/kjae.2004.46.2.236

Abstract

Severe upper airway obstruction due to thyroid cancer is often related severe hypoxia and hypercarbia during anesthesia induction. Attempts to insert an endotracheal tube or a bronchoscope may cause complete immediate airway obstruction. We anesthetized two patients. One had a large mediastinal thyroid mass which compressed trachea and caused near complete obstruction, and the other patient had a large papillary thyroid cancer, which had invaded larynx and compressed the upper trachea. Patients were sedated with fentanyl 150microgram i.v. and a target controlled infusion (TCI, 1.8microgram/ml) of propofol. A femorofemoral cardiopulmonary bypass was performed under local anesthesia. After bypass, the propofol TCI concentration was increased to 3.5microgram/ml, and fentanyl 500microgram and vecuronium 6 mg were injected. Ventilation was performed using a laryngeal mask in one patient, and a laryngeal tube in the other. After removing the tumor mass, the airway was secured, and the cardiopulmonary bypass discontinued. All patients recovered uneventfully and were discharged. We discuss the management of severe upper airway obstruction and the usefulness of cardiopulmonary bypass.

Keyword

airway obstruction; femorofemoral cardiopulmonary bypass; thyroid cancer

MeSH Terms

Airway Obstruction*
Anesthesia
Anesthesia, Local
Anoxia
Bronchoscopes
Cardiopulmonary Bypass*
Fentanyl
Humans
Laryngeal Masks
Larynx
Propofol
Thyroid Gland*
Thyroid Neoplasms*
Trachea
Vecuronium Bromide
Ventilation
Fentanyl
Propofol
Vecuronium Bromide