Anesthetic management in a patient with severe tracheal stenosis by monitoring oxygen reserve index

Sho Matsuba; Mitsuki Sawai; Saki Higashitani; Fumiya Sawasaki; Hiromasa Kida; Kan Takahashi

doi:10.1186/s40981-022-00562-z

Anesthetic management in a patient with severe tracheal stenosis by monitoring oxygen reserve index

JA Clin Rep. 2022 Sep 15;8(1):73. doi: 10.1186/s40981-022-00562-z.

Authors

Sho Matsuba¹, Mitsuki Sawai², Saki Higashitani², Fumiya Sawasaki², Hiromasa Kida², Kan Takahashi²

Affiliations

¹ Department of Anesthesiology, Kanazawa Medical University, 1-1, Daigaku, Uchinada-cho, Kahoku-gun Ishikawa, 920-0293, Japan. sho-8200@kanazawa-med.ac.jp.
² Department of Anesthesiology, Kanazawa Medical University, 1-1, Daigaku, Uchinada-cho, Kahoku-gun Ishikawa, 920-0293, Japan.

Abstract

Background: General anesthesia for tracheal stenting is challenging because of difficult ventilation and accompanying hypoxia. We report the use of oxygen reserve index (ORi™) during tracheal stenting.

Case presentation: Cauterization of an intratracheal tumor and tracheal stenting was scheduled in a patient. ORi decreased from 0.3 to 0.2 after starting cauterization using a flexible bronchoscope through a tracheal tube with 28% oxygen, while SpO₂ was maintained at 100%. ORi further decreased to 0, followed by a decrease of SpO₂ < 90%, and surgery was interrupted. SpO₂ was increased shortly after increasing FiO₂ to 1.0, but ORi remained 0 when surgery was resumed; it was increased after completion of cauterization. Both ORi and SpO₂ were maintained above 0.4 and 98%, respectively, during tracheal stenting through a rigid bronchoscope under intrapulmonary percussive ventilation.

Conclusion: ORi was useful for predicting a decrease of SpO₂ under general anesthesia for tracheal stenting.

Keywords: General anesthesia; IPV®; ORi™; Respiratory management; Tracheal stent placement.