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Report of two cases of endobronchial tumour mass resection in children
Mathias Johansen1, Indrani Lakheeram2, Natalie Buu2
1Department of Pediatric Anesthesia, Montreal Children's Hospital, 1001 Blvd Decarie, Montreal, QC, H4A 3J1, Canada. mathias.johansen@regionh.dk.
Insights
Pediatric endotracheal tumor resection requires careful anesthesia management. Multidisciplinary collaboration and maintaining spontaneous breathing are key for successful shared airway surgery in children.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Airway Management
Background:
- Endotracheal tumor resection in pediatric patients presents unique anesthetic challenges.
- Shared airway surgery necessitates meticulous perioperative planning and execution.
Observation:
- Two pediatric cases involving endotracheal tumor resection are presented.
- Key considerations included decreased pulmonary function, Jehovah's Witness religious beliefs, bleeding risks, and airway collapse.
- One patient had a history of respiratory issues, including asthma and dyspnea.
Findings:
- Multidisciplinary team collaboration and clear communication are crucial for managing shared airways in pediatric patients.
- Maintaining spontaneous respiration is vital to prevent hypoxemia during these high-risk procedures.
- Extracorporeal membrane oxygenation (ECMO) should be considered preoperatively.
Implications:
- Nasal high flow oxygen therapy shows promise for shared airway surgery in pediatric patients.
- This case report highlights the importance of tailored anesthetic strategies for rare pediatric airway tumors.
- Further research into novel airway management techniques is warranted.
Purpose:
Anesthesia for endotracheal tumour mass resection in pediatric patients is a rare, complex, and high-risk procedure. The purpose of this case report is to emphasize the importance of multidisciplinary team collaboration and close communication during the perioperative management of shared airway surgery.
Clinical Features:
A six-year-old boy with no previous history of comorbidity and a 13-yr-old boy with a six-month history of upper respiratory tract infection, refractory asthma, chronic wheeze, and exercise-related dyspnea presented for acute endobronchial tumour mass resection. Decreased pulmonary function, religious beliefs (Jehovah's Witness), risk of intraluminal bleeding, and imminent complete airway collapse constitute areas of specific interest.
Conclusion:
Anesthesia for endotracheal tumour mass resection in pediatric patients is a rare, complex, and high-risk procedure. Decreased pulmonary function and low respiratory reserves combined with the need for extensive surgical airway access warrants multidisciplinary team collaboration and close communication. Maintaining spontaneous respiration is paramount to reduce the risk of hypoxemia-induced adverse events and preoperative considerations should include the possible need for extracorporeal membrane oxygenation. Finally, the use of nasal high flow for shared airway surgery shows promising prospects warranting further investigation.
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