PDF(Pubmed)
Abstract：
Lung cancer is the leading cause of cancer death worldwide. It may present as airway obstruction in a patient with endobronchial masses. Endobronchial brachytherapy (EBBT) has been shown to provide palliative therapy. It is the insertion of a radioactive material near the mass to reduce tumor size, thereby improving airway obstruction. This is the first case of EBBT done in our institution during the COVID-19 pandemic. A 53-year-old male, 60 kg, ASA Physical Status 2 for hypertension, smoker, malignancy, and previous pulmonary tuberculosis patient, presented with a cough and dyspnea. An endobronchial mass almost obstructing the right mainstem bronchus was seen on a computed tomography (CT) scan. He was diagnosed with squamous cell carcinoma of the lung and underwent radiotherapy and erlotinib chemotherapy. On repeat CT scan, there was no noted decrease in the size of the mass. EBBT was suggested, and a multi-disciplinary team was formed for the planned procedure. Pulmonology, radiation oncology, and anesthesiology teams were identified, and thorough planning was done prior to the actual procedure. Three fractions of EBBT were done under sedation using midazolam, fentanyl, and dexmedetomidine infusion. Lidocaine spray and transtracheal block were also performed as adjuncts prior to sedation. The procedure went as planned, and points for improvement were discussed for subsequent fractions. Due to persistent cough and discomfort from the catheter, additional ipratropium nebulization for minimization of secretions, and oral dextromethorphan for cough suppression were incorporated. After each fraction, the patient was monitored post-procedure for any side effects both from the radiotherapy and anesthetic technique. Qualitative reduction in mass size was noted in subsequent fractions. The patient was able to complete 3 fractions and was advised to follow-up after a month. EBBT is an emerging palliative and treatment modality for lung cancer, especially for intraluminal masses. Anesthetic considerations will depend on each case\'s characteristics such as airway anatomy, patient comfort and capacity, and procedural requirements. Conscious sedation with topical anesthesia is an adequate and appropriate anesthetic option, especially in cases where severe airway obstruction may compromise ventilation if airway reflexes are blunted. A multidisciplinary approach with different services and stakeholders is important for the proper planning, execution, and management of such patients.
摘要：
肺癌是全球癌症死亡的主要原因。它可能表现为支气管内肿块患者的气道阻塞。支气管内近距离放射治疗（EBBT）已被证明可以提供姑息性治疗。它是在肿块附近插入放射性物质以减小肿瘤大小，从而改善气道阻塞。这是我们机构在COVID-19大流行期间进行的第一例EBBT病例。一个53岁的男性,60kg,ASA高血压的身体状态2，吸烟者,恶性肿瘤，和以前的肺结核患者，出现咳嗽和呼吸困难.在计算机断层扫描（CT）扫描中看到几乎阻塞右主支气管的支气管内肿块。他被诊断为肺鳞状细胞癌，并接受了放疗和厄洛替尼化疗。重复CT扫描时,没有注意到质量大小的减少。EBBT被建议，并为计划的程序成立了一个多学科小组。肺科,放射肿瘤学，麻醉小组被确认，并且在实际程序之前进行了彻底的计划。使用咪达唑仑在镇静下完成了三个部分的EBBT，芬太尼,和右美托咪定输注。在镇静之前，利多卡因喷雾剂和经气管阻滞也作为辅助手段。程序按计划进行,并讨论了后续馏分的改进点。由于导管持续咳嗽和不适，额外的异丙托溴铵雾化减少分泌物，并纳入口服右美沙芬抑制咳嗽。在每个分数之后，术后对患者进行放疗和麻醉技术的副作用监测.在随后的级分中注意到质量大小的定性减少。患者能够完成3个部分，并建议在一个月后进行随访。EBBT是肺癌的一种新兴的姑息治疗方式，尤其是腔内肿块。麻醉考虑将取决于每个病例的特征，如气道解剖，患者的舒适度和能力，和程序要求。清醒镇静和局部麻醉是一种适当的麻醉选择，特别是在严重的气道阻塞可能损害通气的情况下，如果气道反射减弱。具有不同服务和利益相关者的多学科方法对于适当规划很重要，执行，以及对此类患者的管理。
