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

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.