Anesthetic Management for Placement of Endobronchial Stent Using PCPS.

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A 49-year-old man was diagnosed with inoperable lung cancer. Tumor growth was so rapid that his dyspnea worsened in spite of several courses of laser treatment. He was then scheduled for endobronchial stent insertion. Inherently his right lung was anaplastic and the right main bronchus was completely occluded by the carcinoma. Over 90% of the left main bronchus was occluded, and the bronchoscopy was impossible to use because of stenosis. As difficulty in placing the endobronchial stent and the possibility of complete occlusion of the airway were expected, percutaneous cardiopulmonary support (PCPS) to maintain oxygenation during apnea was placed.Anesthesia was induced with pentazocine and propofol followed by a propofol infusion to maintain anesthesia without disturbing spontaneous breathing. PCPS was prepared (supporting blood flow: 1∼1.5l•min-1, FIO2: 1.0), then veculonium IV was administered and apnea occluded. After resection and coagulation of the tumor using a Yttrium-Aluminum-Garnet laser, the endobronchial stent was placed into the left main bronchus. Several minutes later, the patient began breathing again and recovered from the anesthesia smoothly.This case suggests that PCPS is useful as an extracorporeal lung assist for surgical procedures involving possible apnea.
日本臨床麻酔学会の論文