Anesthetic Management of Large Bronchogenic Cyst With Severe Tracheal Compression in Adults: A Case Report

TL;DR

This case report details the anesthetic management of an adult with a large bronchogenic cyst causing severe tracheal compression, highlighting the challenges and strategies for safe airway and surgical care.

Contribution

The paper presents a novel case of anesthetic management for a rare condition with near-complete tracheal compression using specific techniques.

Findings

Awake fiberoptic intubation and one-lung ventilation with an EZ bronchial blocker ensured airway security and surgical conditions.

The case emphasizes the importance of meticulous planning for patients with mediastinal masses causing tracheal compression.

Perioperative safety was achieved through understanding pathophysiology and anticipating complications.

Abstract

Bronchogenic cysts (BCs) are a congenital anomaly, forming fluid-filled sacs in the bronchial tree during fetal development, and are relatively rare in adults. Patients with large BCs in the mediastinum presenting with severe tracheal compression pose a significant challenge to anesthesiologists. The confined and narrow space of the mediastinum exacerbates the compression effect on surrounding structures, leading to potential respiratory or cardiovascular collapse during anesthesia and postoperatively. Herein, we report the stepwise anesthetic management of a patient with a BC in the paratracheal region of superior mediastinum, causing near-complete tracheal compression, scheduled for right posterolateral thoracotomy and tumor excision. The patient presented with dyspnea, chest pain, cough, and severe tracheal compression necessitating meticulous airway management. Utilizing awake fiberoptic intubation with a single-lumen endotracheal tube and one-lung ventilation facilitated by an EZ bronchial blocker, we successfully secured the airway, provided ideal surgical conditions through lung deflation, and ensured perioperative safety. This case underscores the crucial role of comprehending the underlying pathophysiology, anticipating complications, and meticulously planning, preparing, and executing strategies for airway management and perioperative care in patients with mediastinal masses leading to significant tracheal compression.

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