Low Carinal Tumor & Ventilatory Management : An Anesthetic Challenge

Abstract

Surgical resection of carinal tumors is an anesthetic as well as surgical challenge ,which requires meticulous
planning and good interaction between surgical and anesthetic teams for successful outcome. A 30 Yrs old female
presented with a history of progressive dyspnea along with hemoptysis since 2 yrs that aggravated from last 6
months posted electively for carinal mass biopsy along with resection. Clinical examination revealed no air entry
on left side & slightly decreased air entry towards right side. CT scan of chest revealed 19×15mm carinal mass
causing complete obstruction of left main stem bronchus & partial obstruction of right main stem bronchus p/o
bronchial carcinoid. Patient was managed with Apneic ventilation technique along with intermittently EtCO2
monitoring done during mask ventilation. Our aim was to maintain patent airway , adequate oxygenation and
ventilation with readiness to deal excessive bleeding. We allowed just partial resection biopsy as tumor was of
bleed on touch variety. Patient was managed successfully with vigilant actions to abandon the procedure timely
with good postoperative outcome