Choice of induction with, or standby of, extracorporeal lung assist (ECLA) in anesthetic management of bronchoscopic yttrium-aluminium-garnet (YAG) laser treatment of airway tumor

Bronchoscopy with an yttrium-aluminium-garnet (YAG) laser is often used to resect benign and malignant airway tumors and for relief of associated airway stenosis. Complications of this procedure include airway obstruction and hemorrhage. Partial extracorporeal circulation for YAG laser resection in the airway may be helpful in minimizing these complications. Extracorporeal lung assist (ECLA) should be available for such bronchoscopic surgery, although it is not always required. We managed the general anesthesia for bronchoscopic YAG laser resection of airway tumors in two patients. The first case was a 60-year-old man with a right bronchial tumor that had invaded into the trachea across the carina. The narrowest inner diameter of the part of the trachea affected by the lesion was 3 mm. ECLA was initiated for a bronchoscopic YAG laser resection. The second case was a 74-year-old woman with a metastastic lung tumor from osteosarcoma. The narrowest inner diameter of the lesion in the right truncus intermedius was 4 mm. ECLA was kept on standby for possible complications in the bronchoscopic YAG laser resection. These treatments were completed successfully in both patients without any adverse events. ECLA is a useful supporting technique for performing bronchoscopic YAG laser treatment safely ECLA is recommended where a bronchial lesion invades the trachea and crosses the carina, and where a tracheal lesion will not allow passage of a tracheal tube under the bronchoscope. However, ECLA may be kept on standby for a airway tumor limited to one main bronchus, and for a peripheral bronchial lesion, and even for an invasive tracheal lesion through which the tracheal tube under the bronchoscope can pass. Whether it is used or kept on standby depends on the location and severity of airway compromise caused by the airway lesions.