[Safe induction of anesthesia in 3 patients with severe tracheal stenosis caused by thyroid cancer].

Anesthetic induction in a patient with a giant thyroid cancer is challenging for anesthetists. Tracheostomy under local anesthesia is usually impossible in these cases because the tumor mass occupies the anterior mediastinum and interferes with the approach to the trachea. The tumor may further cause tracheal stenosis and laryngeal malformation, leading to airway complications including difficult ventilation, difficult intubation, airway hemorrhage or swelling, and suffocation in the patient. Extracorporeal membrane oxygenation (ECMO) or high-frequency jet ventilation (HFJV) is reported to be a useful tool for safe induction in these patients; however, each of them alone would leave a possibility of inadequate oxygenation. We successfully managed anesthesia using both ECMO and HFJV in 3 patients with imminent danger of airway obstruction due to an extra-large thyroid cancer. A combination of ECMO and HFJV may be a useful tool for safe induction of anesthesia in patients with severe tracheal stenosis.