[Respiratory Management in a Patient with Severe Tracheal Stenosis Caused by Compression from the Ascending Aortic Arch Aneurysm]

In cases of tracheal compression by a mediastinal mass or aortic aneurysm, muscle relaxant might induce fetal ventilatory failure. It is known to be valuable to keep spontaneous breathing in these cases. A 42-years-old woman complicated with Marfan syndrome had acute respiratory failure due to acute progression of tracheal stenosis caused by compression from the ascending and aortic pseudoaneurysm. After the induction of general anesthesia for video-assisted thoracic surgery (VATS) for high-pneumothorax, she was placed in lateral position. Suddenly it became difficult to ventilate her and her oxygenation saturation declined with bradycardia. We returned her to supine position and then could manage to ventilate her easier. But we could not maintain stable ventilation until her spontaneous breathing appeared. VATS was cancelled and she was brought in to the ICU after extubation. In the ICU she developed respiratory distress again soon and was reintubated under consciousness guided by bronchofiber scope. We managed successfully to keep spontaneous breathing intact under proper sedation by three sedative drugs; propofol, midazolam and morphine for 5 days until the next operation. We realized the importance of maintaining spontaneous breathing under proper sedation in a case of severe tracheal stenosis.