[Successful airway management using a Cook airway exchange catheter as an emergent dilator for life-threatening neoplastic stenosis of the trachea: a case report].
A 68-year-old male patient was referred to our hospital for his intractable and progressive dyspnea. Chest roentgenography and computerized tomography revealed severe lower tracheal stenosis due to neoplastic invasion. The tumor completely surrounded his trachea for 5 cm length and the remaining internal diameter of the trachea was less than 5 mm. To avoid fatal asphyxia, emergency airway security was required. After placing both femoral arterial and venous cannulae for percutaneous cardiopulmonary support system, we dilated the stenotic trachea using a Cook airway exchange catheter (CAEC), and then an armored tube of 7 mm inner diameter was introduced through the CAEC. The maneuver was smoothly completed within one minute without any complications. His dyspnea was completely relieved. Following chemotherapy and radiotherapy were so effective that the endotracheal tube was extubated two weeks later uneventfully. After several series of chemotherapy and 50 Gy irradiation, the patient was discharged three months later without symptoms. We concluded that CAEC could be one of the life-saving instruments for emergent airway management in case of severe organic tracheal stenosis.
Nomoto
Koichi
K
Department of Anesthesiology and Critical Care Medicine, Omiya Medical Center, Jichi Medical School, Saitama 330-8503.
Otsuka
Yuji
Y
Nishimura
Mitsuo
M
Inada
Shinji
S
Murayama
Takanori
T
Seo
Norimasa
N
D000368:Aged; D018288:Carcinoma, Small Cell / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D004106:Dilatation / Q000295:instrumentation*; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D008297:Male; D014135:Tracheal Stenosis / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome