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Esophageal polyp as a posterior mediastinal mass: Intraoperative dynamic airway obstruction requiring emergency tracheostomy.

Sen S, Chhabra A, Ganguly A, Baidya DK - J Anaesthesiol Clin Pharmacol (2014)

Bottom Line: Anesthesia in the presence of a mediastinal mass is difficult and challenging as the mass can involve or compress the heart, great vessels, tracheo-bronchial tree and the surrounding structures.We describe a case of severe tracheo-bronchial obstruction requiring emergency tracheostomy during the intraoperative period after an uneventful induction of anesthesia in a patient with a large esophageal polyp presenting as a posterior mediastinal mass.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Anesthesia in the presence of a mediastinal mass is difficult and challenging as the mass can involve or compress the heart, great vessels, tracheo-bronchial tree and the surrounding structures. We describe a case of severe tracheo-bronchial obstruction requiring emergency tracheostomy during the intraoperative period after an uneventful induction of anesthesia in a patient with a large esophageal polyp presenting as a posterior mediastinal mass.

No MeSH data available.


Related in: MedlinePlus

Large esophageal polyp taken out by transcervical route, flexible endotracheal tube seen passing through the tracheostomy stoma
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Figure 1: Large esophageal polyp taken out by transcervical route, flexible endotracheal tube seen passing through the tracheostomy stoma

Mentions: After an oblique cervical incision, esophagotomy was performed and the polyp was attempted to be pulled up. Initial 3-4 cm of the mass was exited smoothly but after that increasing resistance was encountered and the polyp could not be pulled up any further. Airway pressure increased from 18 to 42 cm H2O. Manual ventilation was started. Any ETT kinking/obstruction, distal migration into the bronchus and bronchospasm were ruled out. Manual ventilation became increasingly difficult, end-tidal CO2 reached 65-70 mm Hg and airway pressure 40-45 cm H2O. Increased external compression of the tracheobroncheal tree by the pulled up polyp was likely diagnosis. Attempts to push the mass back into the mediastinum with an expectation to relieve the obstruction also failed. Oxygen saturation decreased to 86%. Emergency tracheostomy was immediately performed which revealed a compressed ETT inside trachea; a gum-elastic bougie was introduced into the tracheostomy stoma and a reinforced flexometallic 8.0-mm ETT was advanced over the bougie forcibly to bypass the obstruction. Immediately airway pressure declined and SpO2 improved. Rest of intraoperative course remained uneventful. The mass was successfully retrieved transcervically and resected [Figure 1]. His tracheostomy tube was decannulatd after 2 weeks after ruling out any possible tracheomalacia.


Esophageal polyp as a posterior mediastinal mass: Intraoperative dynamic airway obstruction requiring emergency tracheostomy.

Sen S, Chhabra A, Ganguly A, Baidya DK - J Anaesthesiol Clin Pharmacol (2014)

Large esophageal polyp taken out by transcervical route, flexible endotracheal tube seen passing through the tracheostomy stoma
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927304&req=5

Figure 1: Large esophageal polyp taken out by transcervical route, flexible endotracheal tube seen passing through the tracheostomy stoma
Mentions: After an oblique cervical incision, esophagotomy was performed and the polyp was attempted to be pulled up. Initial 3-4 cm of the mass was exited smoothly but after that increasing resistance was encountered and the polyp could not be pulled up any further. Airway pressure increased from 18 to 42 cm H2O. Manual ventilation was started. Any ETT kinking/obstruction, distal migration into the bronchus and bronchospasm were ruled out. Manual ventilation became increasingly difficult, end-tidal CO2 reached 65-70 mm Hg and airway pressure 40-45 cm H2O. Increased external compression of the tracheobroncheal tree by the pulled up polyp was likely diagnosis. Attempts to push the mass back into the mediastinum with an expectation to relieve the obstruction also failed. Oxygen saturation decreased to 86%. Emergency tracheostomy was immediately performed which revealed a compressed ETT inside trachea; a gum-elastic bougie was introduced into the tracheostomy stoma and a reinforced flexometallic 8.0-mm ETT was advanced over the bougie forcibly to bypass the obstruction. Immediately airway pressure declined and SpO2 improved. Rest of intraoperative course remained uneventful. The mass was successfully retrieved transcervically and resected [Figure 1]. His tracheostomy tube was decannulatd after 2 weeks after ruling out any possible tracheomalacia.

Bottom Line: Anesthesia in the presence of a mediastinal mass is difficult and challenging as the mass can involve or compress the heart, great vessels, tracheo-bronchial tree and the surrounding structures.We describe a case of severe tracheo-bronchial obstruction requiring emergency tracheostomy during the intraoperative period after an uneventful induction of anesthesia in a patient with a large esophageal polyp presenting as a posterior mediastinal mass.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Anesthesia in the presence of a mediastinal mass is difficult and challenging as the mass can involve or compress the heart, great vessels, tracheo-bronchial tree and the surrounding structures. We describe a case of severe tracheo-bronchial obstruction requiring emergency tracheostomy during the intraoperative period after an uneventful induction of anesthesia in a patient with a large esophageal polyp presenting as a posterior mediastinal mass.

No MeSH data available.


Related in: MedlinePlus