Xu XH, Gao H, Chen XM, Ma HB, Huang YG. Using ketamine in a patient with a near-occlusion tracheal tumor undergoing tracheal resection and reconstruction: A case report. World J Clin Cases 2022; 10(23): 8417-8421 [PMID: 36159522 DOI: 10.12998/wjcc.v10.i23.8417]
Corresponding Author of This Article
Hui Gao, MD, Doctor, Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. hellohigh@163.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Han Xu, Hui Gao, Yu-Guang Huang, Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Xing-Ming Chen, Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Hao-Bo Ma, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Author contributions: Xu XH and Gao H participated in the anesthesia management of the present case, and both were the major contributors of this manuscript; Chen XM completed the surgical procedure; Ma HB and Huang YG helped revise the manuscript; all authors read and approved the final manuscript.
Informed consent statement: A written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: The authors have nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Gao, MD, Doctor, Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. hellohigh@163.com
Received: April 18, 2022 Peer-review started: April 18, 2022 First decision: May 12, 2022 Revised: May 25, 2022 Accepted: July 5, 2022 Article in press: July 5, 2022 Published online: August 16, 2022 Processing time: 104 Days and 21.9 Hours
Abstract
BACKGROUND
Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation. Due to its rarity, there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors, therefore individualized strategies are necessary. There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction (TRR) in the literature. We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.
CASE SUMMARY
A 25-year-old female reported progressive dyspnea and hemoptysis. Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis, which occluded > 90% of the tracheal lumen. The patient was scheduled for TRR. Considering the risk of complete airway collapse after the induction of general anesthesia, we decided to secure the airway with a tracheostomy with spontaneous breathing. The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders: a time-consuming process. Coughing and movement needed be minimized; thus, we added intravenous ketamine to local anesthetic infiltration. After tracheostomy, an endotracheal tube was placed into the distal trachea, and general anesthesia was induced. The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall. We performed a video-laryngoscopy to place a new endotracheal tube. Finally, the surgeons anastomosed the anterior tracheal walls. The patient was extubated uneventfully.
CONCLUSION
Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.
Core Tip: The anesthetic management of upper tracheal resection and reconstruction (TRR) is challenging, since the tracheal tumor poses a significant risk to the patient’s ventilation and oxygenation. In a patient with a near-occlusion upper tracheal tumor, we successfully maintained spontaneous breathing during tracheostomy in TRR with anesthesia provided by intravenous ketamine and local anesthetic infiltration. Ketamine shows great advantages in providing adequate analgesia and cough suppressant effects with minimal respiratory depression. We hope our experience adds to the knowledge of airway management of upper TRR.
