Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8417-8421
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8417
Using ketamine in a patient with a near-occlusion tracheal tumor undergoing tracheal resection and reconstruction: A case report
Xiao-Han Xu, Hui Gao, Xing-Ming Chen, Hao-Bo Ma, Yu-Guang Huang
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
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.

Keywords: Ketamine, Near-occlusion, Upper tracheal tumor, Tracheal resection and reconstruction, Tracheostomy, Case report

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.