[Anesthetic management of laser surgery using PCPS for tracheal tumor]

Primary tracheal cancer is extremely rare, but critical tracheal stenosis is seen in many cases. Although laser resection or stent placement is performed under general anesthesia, anesthetic management for tracheal tumor is extremely difficult in terms of airway management. We report a 65-year-old woman scheduled to undergo bronchoscopic laser surgery and insertion of Dumon stent for tracheal tumor which severely obstructed the upper airway. Anesthesia was maintained with propofol, fentanyl and dexmedetomidine. Percutaneous cardiopulmonary support (PCPS) was established via the femoral artery and vein prior to induction of anaesthesia. Tumor resection was performed, but the stent placement was cancelled because a rigid bronchoscope could not be inserted due to difficult laryngeal exposure. Tracheostomy was then performed after weaning from PCPS. Although desaturation due to unsuccessful venous drainage and difficult ventilation by laryngeal edema during the operation and tracheal obstruction by a clot after the operation was observed, the patient's clinical condition improved. In cases of severe tracheal stenosis, airway obstruction by hemorrhage, secretion and laryngeal edema, etc. occur easily. Therefore, some kind of measures should be taken for the operation and a number of precautions must be taken during the perioperative period.