One-lung ventilation in a patient with stenting for tracheobronchial stenosis caused by esophageal cancer

Abstract

We have provided general anesthesia for a 53-year-old man scheduled to undergo lymph node removal for right mediastinal lymph node metastases caused by esophageal cancer. One year prior, acute respiratory failure occurred because of stenosis of the carinal bifurcation resulting from advanced esophageal cancer with tracheal invasion. The patient underwent placement of tracheobronchial stents (Spiral Z Stent) in two locations (left main bronchus and trachea/right main bronchus), followed by radiotherapy and chemotherapy. In the present case, after an 8.5-mm-ID tracheal tube was placed under bronchoscopic guidance, a 7.0 Fr. bronchial blocker (Arndt Endobronchial Blocker; Cook, Bloomington, IN, USA) was carefully inserted into the stent in the right main bronchus. Next, 3ml air was injected into the blocker cuff, and left-sided one-lung ventilation was performed. After surgery was completed, the bronchial blocker was removed under bronchoscopic guidance. We confirmed there was no tracheobronchial injury nor stent displacement or deformation, then removed the tracheal tube. Even in patients with tracheobronchial stent placement, one-lung ventilation can be safely and reliably performed by selecting an appropriate bronchial blocker, along with careful insertion into the stent and frequent checking of the blocker position.