[Anesthetic management using veno-veno bypass for emergent tracheostomy in a patient with acute epiglottitis]

We report anesthetic management using veno-veno bypass (V-V bypass) for emergent tracheostomy in a patient with acute epiglottitis. A 72-year-old woman complained of dyspnea due to acute epiglottitis, and emergent tracheostomy was planned for her. Since physical and optical fiberscopic examinations indicated a high risk of airway collapse during anesthetic induction, we planned to do tracheostomy under V-V bypass in order to maintain oxygenation. V-V bypass was established using the right femoral and jugular veins in an awake condition. After starting V-V bypass, tracheostomy was performed under intravenous propofol anesthesia. During surgery, bispectral index was maintained below 60. Surgery was carried out with ease and uneventfully. The patient had no complications due to V-V bypass postoperatively.