Poster Presentation: Airway Emergency Following Pulmonary Cryoablation in the Non-operating Room Setting-Airway Emergency Following Pulmonary Cryoablation in the Non-operating Room Setting

Airway Emergency Following Pulmonary Cryoablation in the Non-operating Room Setting

Pdf Summary

The document discusses the anesthesia management for pulmonary cryoablation, a minimally invasive procedure used to treat non-operable lung lesions. This procedure involves the use of a cryoprobe inserted percutaneously to freeze and destroy cancer cells under computed tomography (CT) guidance. Although low-risk, cryoablation can lead to severe complications such as hemoptysis and pneumothorax, especially in older patients with multiple comorbidities.<br /><br />The document emphasizes the necessity for anesthesia providers to be well-informed about these procedures and their associated risks. It advocates for the development of practice guidelines to standardize and improve patient care in remote settings where such procedures are conducted. Anesthesia providers should ensure the availability of various endotracheal tube (ETT) sizes, double lumen tubes, bronchial blockers, and cross-matched blood products for potential bleeding emergencies. Understanding the procedural implications helps in effectively coordinating an interdisciplinary approach to manage adverse events and enhance patient outcomes.<br /><br />The case report details the management of a 73-year-old female with metastatic uterine cancer who underwent left lung cryoablation after experiencing a pneumothorax from a prior right lung ablation. Under general anesthesia, with airway secured by a 7.0 mm ETT, the procedure proceeded until ventilation abruptly halted post-neuromuscular blockade reversal. A CT scan revealed an occlusive clot at the tracheal carina. An emergency endotracheal clot retrieval was performed using a cryoprobe, transitioning the patient to total intravenous anesthesia with propofol. An 8.0 mm ETT was then used for bronchoscopy, and the clot was successfully evacuated through cryoadhesion. The patient remained hemodynamically stable, was transferred to the ICU, and extubated the next day, being discharged four days post-operatively.<br /><br />The report concludes by highlighting the importance of thorough preparation and risk stratification in lung cryoablation, emphasizing the need for specialized equipment and expertise to manage complications promptly.

Keywords

anesthesia management

pulmonary cryoablation

lung lesions

computed tomography

hemoptysis

pneumothorax

endotracheal tube

bronchoscopy

interdisciplinary approach

risk stratification