ACA App
Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Submission | Subscribe | Advertise | Contact | Login 
Users online: 1884 Small font size Default font size Increase font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
     
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed314    
    Printed8    
    Emailed0    
    PDF Downloaded20    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents
INTERESTING IMAGES  
Year : 2021  |  Volume : 24  |  Issue : 4  |  Page : 498-499
Anesthetic management of right brachiocephalic artery aneurysm causing tracheal compression


1 Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
2 Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India

Click here for correspondence address and email

Date of Submission11-Aug-2020
Date of Decision27-Sep-2020
Date of Acceptance30-Oct-2020
Date of Web Publication18-Oct-2021
 

   Abstract 


The airway compression poses a challenge for the anesthesiologist in airway management during aneurysm repair surgery.

Keywords: Aortic arch, right subclavian artery, pseudo aneurysm

How to cite this article:
Arora V, Shah R, Patel H, Wadhawa V. Anesthetic management of right brachiocephalic artery aneurysm causing tracheal compression. Ann Card Anaesth 2021;24:498-9

How to cite this URL:
Arora V, Shah R, Patel H, Wadhawa V. Anesthetic management of right brachiocephalic artery aneurysm causing tracheal compression. Ann Card Anaesth [serial online] 2021 [cited 2021 Nov 30];24:498-9. Available from: https://www.annals.in/text.asp?2021/24/4/498/328524





   Introduction Top


A 34-year-old male admitted in our institute with a history of hoarseness of voice since 15 days, pain over right shoulder since 4 days and difficulty in breathing since 3 days. Chest X Ray showed a well-defined radio-opacity in right paratracheal location, causing mass effect in the form of displacement of trachea to left side [Figure 1]. Computerized Tomography scan revealed pseudo aneurysm arising from junction of right common carotid artery and subclavian artery with peripheral thrombosis [Figure 2]. The surgical plan was to exclude the aneurysm and reduce the volume of aneurysm to reduce the compression on the trachea. The open surgical repair was planned under cardiopulmonary bypass (CPB).[1],[2],[3],[4],[5]
Figure 1: A well-defined radio-opacity is seen in right paratracheal location, causing mass effect in the form of displacement of trachea to left side. The lesion is seen extending above the clavicle. Impression:-superior mediastinal mass with mass effect on trachea

Click here to view
Figure 2: CTA coronal image showing aneurysm arising from right brachiocephalic artery and compressing the tracheal lumen

Click here to view


Peripheral Bypass instituted under local anesthesia and patient was taken on CPB. Patient was induced and intubated and put on mechanical ventilation after institution of CPB. Bronchoscopy was done and Endotracheal Tube (ETT) was placed beyond tracheal compression and no tracheal rent was noted. Patient was weaned off CPB uneventfully. The patient was extubated on post-operative day 1 after TPiece Trial.


   Discussion Top


Patients with aneurysm of Aortic Arch and its branches pose a challenge for the anesthesiologist in airway management during aneurysm repair surgery. During induction of anesthesia there may occur collapse of airway after administration of induction drugs due to skeletal muscle relaxation. This may result in sudden and marked hypoxia if airway patency is not established promptly via endotracheal intubation. In case of severe tracheal compression, it may be very difficult to intubate and bypass tracheal compression via endotracheal tube. Therefore, a decision of awake peripheral cannulation and establishment of CPB was planned.[5] Tracheomalacia can be associated with congenital aortic arch abnormalities.[2] This case highlights the importance of formulating a plan for the anesthetic management of patients with aneurysm of aortic branch causing severe tracheal compression and preparedness for postoperative management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kumar A, Dutta V, Negi S, Puri GD. Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm. Ann Card Anaesth 2016;19:568-71.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sebening C, Jakob H, Tochtermann U, Lange R, Vahl CF, Bodegom P, et al. Vascular tracheobronchial compression syndromes – Experience in surgical treatment and literature review. Thorac Cardiovasc Surg 2000;48:164-74.  Back to cited text no. 2
    
3.
Koomen E, Schurink GW, Mochtar B, Jacobs MJ, Smets RJ. Repair of thoracic aortic aneurysm associated with tracheal and right main stem bronchus compression. J Cardiothorac Vasc Anesth 2007;21:88-90.  Back to cited text no. 3
    
4.
Maddans M, Pearson FG. Tracheomalacia. In: Pearson FG, editor. Thoracic Surgery. New York: Churchill Livingstone; 2002. p. 272-6.  Back to cited text no. 4
    
5.
Von Segesser LK. Peripheral cannulation for cardiopulmonary bypass. Multimed Man Cardiothorac Surg 2006:mmcts. 2005.001610. doi: 10.1510/mmcts.2005.001610.  Back to cited text no. 5
    

Top
Correspondence Address:
Varun Arora
Department of Cardiac Anestheisa, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_195_20

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top