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Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives


1 Department of Cardiac Anesthesia, Dharma Vira Heart Centre, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
3 Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, India
4 Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
Aman Jyoti
Department of Cardiac Anesthesia, Dharma Vira Heart Centre, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi - 110 060
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124147

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Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 62-66

 

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The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB). Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization) from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.






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1 Department of Cardiac Anesthesia, Dharma Vira Heart Centre, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
3 Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, India
4 Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
Aman Jyoti
Department of Cardiac Anesthesia, Dharma Vira Heart Centre, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi - 110 060
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124147

Rights and Permissions

The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB). Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization) from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.






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