Alfentanil and propofol induced anesthesia for patients with huge endotracheal tumor undergoing fiberoptic bronchoscopic interventional therapy: case report

Abstract

Background: There is a high risk of hypoxia or apnea for patients with huge tracheal tumor during general anesthesia. Here we reported two cases of extremely huge endotracheal tumors undergoing fiberoptic bronchoscopic interventional therapy under general anesthesia. We hope the experience will be of reference value for formulating reasonable anesthesia scheme for such critically ill patients.

Case description: The two patients were accompanied with severe respiratory distress. And fiberoptic bronchoscopy revealed that the trachea cavity was blocked nearly completely by extremely huge tracheal tumor. Tracheal tumors were scheduled to be removed with fiberoptic bronchoscopic interventional therapy. General anesthesia was inducted with alfentanil and propofol. Then a laryngeal mask was inserted and spontaneous breath was preserved. During the operation, complete airway obstruction occurred, but it was effectively handled by using the fiberoptic bronchoscope to push the tumor and reopen the gap between the mass and the tracheal wall. After the therapy, the patients' symptom of respiratory distress was relieved significantly.

Conclusions: For patients with huge tracheal tumor that to be handled with fiberoptic bronchoscopic interventional therapy, general anesthesia with spontaneous breath induced by alfentanil and propofol is preferable. The most important, when complete airway blockade occurs during the process, pushing the tumor and reopening the respiratory tract with fiberoptic bronchoscope is a fairly effective solution to enable patients to be reoxygenated.

Keywords: Alfentanil; case report; endotracheal tumor; fiberoptic bronchoscopic interventional therapy; general anesthesia.

Figure 1

Images of the endotracheal tumor before and after the electrocision under fiberoptic bronchoscopy. There was only a small gap between the tumor and the tracheal wall (A). The texture of the tumor is soft, and fiberoptic bronchoscope could pass through the gap between the tumor and tracheal wall, and the tip of fiberoptic bronchoscope could hold up the tumor locally, thus enlarge the gap and improve the breathing of the patient (B). Partial tumor was successfully removed, which greatly relieved the symptoms of dyspnea (C). After radiotherapy, the tracheal tumor disappeared and the symptom of airway obstruction was completely relieved (D).

Figure 2

Images of the endotracheal tumor before and after endotracheal stent implementation under fiberoptic bronchoscopy. The mass occupied nearly all the space of the trachea (A,B). The airway was reopened after the fiberoptic bronchoscope was inserted into the trachea and pushed the tumor away (C). The texture of the tumor is so hard that only a very small part of the mass was removed (D). An endotracheal stent was placed to temporarily relieve dyspnea prior to operation (E,F).