[Anesthetic Management with V-V ECMO in a Patient with Severe Tracheal Stenosis]

We here report a case in which tracheal stent insertion was performed using veno-venous extracorporeal membrane oxygenation (V-V ECMO). A 78-year-old man with severe tracheal stenosis due to thyroid cancer was suffering from dyspnea at rest. Computed tomography showed that the narrowest caliber of the trachea was 1.5 mm in diameter at 5 cm below the level of the vocal cords. Femoro-femoral V-V ECMO was established without hemodynamic instability. General anesthesia was induced with propofol 70 mg and fentanyl 50 μg and was maintained with propofol 150-200 mg x hr(-1) and remifentanil 0.3-0.5 mg x hr(-1) using target-controlled infusion devices. Mask ventilation was possible, and the trachea could be intubated. A rigid bronchoscope was advanced to the stenosis site after removing the endotracheal tube. Manual ventilation via a side port of the uncuffed bronchoscope could not achieve normal inflation of the both chest walls because of air leaks. Throughout the procedures, hypoxemia and hypercapnia could be prevented by manual ventilation supplemented with low-flow V-V ECMO. Stent implantation was performed successfully. This case suggests that V-V ECMO is useful for providing supplementary oxygenation and carbon dioxide elimination when adequate ventilation cannot be provided during tracheal stent implantation.