Peripheral Cardiopulmonary Bypass in Two Patients With Symptomatic Tracheal Masses: Perioperative Challenges

Satyajeet Misra, Bikram Kishore Behera, Chappity Preetam, Satyapriya Mohanty, Rudra Pratap Mahapatra, Priyank Tapuria, Anirudh Elayat, Anindya Nayak, Kunal Kotkar, John S. McNeil, Randal S. Blank

Research output: Contribution to journalArticlepeer-review

Abstract

Tracheal tumors or masses causing critical airway obstruction require resection for symptom relief. However, the location and extent of these tumors or masses often preclude conventional general anesthesia and tracheal intubation. Peripheral cardiopulmonary bypass often is required before anesthetizing these patients. Herein, two cases of patients with tracheal masses, in whom awake peripheral cardiopulmonary bypass was instituted, are reported. The first case was that of an obese male child weighing 102 kg, with tracheal rhinoscleroma, who developed Harlequin, or north-south, syndrome after institution of femorofemoral venoarterial partial cardiopulmonary bypass. The second case was that of a female patient with adenoid cystic carcinoma of the trachea causing near-total central airway occlusion. She had severe pulmonary artery hypertension, which prevented the use of venovenous bypass. Instead, femoral vein-axillary artery venoarterial bypass was established to avoid Harlequin syndrome. Some of the challenges encountered were the development of Harlequin syndrome with risk of myocardial and cerebral ischemia, type and conduct of extracorporeal bypass, choice of monitoring sites, and provision of regional anesthesia for peripheral extracorporeal cannulations. Management of such patients needs frequent troubleshooting and multidisciplinary coordination for a successful surgical outcome.

Original languageEnglish
Pages (from-to)1524-1533
Number of pages10
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume35
Issue number5
DOIs
StatePublished - May 2021

Keywords

  • Harlequin syndrome
  • north-south syndrome
  • peripheral cardiopulmonary bypass
  • tracheal tumor
  • venoarterial bypass
  • venovenous bypass

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