Combined conventional and jet ventilation in airway management in tracheal tumor

Tumors on the carina are uncommon, and their anesthetic management can present a considerable challenge. The principle anesthetic consideration is ventilation and oxygenation in the face of an open airway. A 60-year-old man patient suffered a carinal tumor, which occupied 70% of the both main bronchi and bled spontaneously while coughing. Surgical resection and reconstruction were done. The carinal surgical approach was a right posterolateral thoracotomy, and the patient was placed in the left decubitus position. Because we could not insert the jet catheter past the mass, high frequency jet ventilation to ventilate the dependent lung could not be applied. Our choice was differential lung ventilation with a combination of conventional and high frequency jet ventilation modes to preserve oxygenation during tumor excision and tracheal reconstruction. An episode of desaturation was successfully treated during removal of tumor. The postoperative course was uneventful. The patient was sent to the intensive care unit after surgery and discharged on the 11th day. He received further combined chemotherapy and radiotherapy during his next admission. Fiberoptic examination on the 5 months later no evidence of recurrence. In summary, we described our airway management on carinal tumor excision, especially the tumor was so large that dependent lung jet ventilation could not employ.