Airway Stenting Under Venoarterial Extracorporeal Membrane Oxygenation (V-A ECMO) Support With Multimodal Sedation Including Remimazolam in a Patient With Central Airway Stenosis: A Case Report

The perioperative anesthetic management of patients with severe airway obstruction due to advanced lung cancer poses significant challenges, and no standardized protocols have been established. A 49-year-old man with severe tracheal stenosis due to extrinsic tumor compression underwent successful airway stenting supported by venoarterial extracorporeal membrane oxygenation (V-A ECMO). Due to the high risk of airway collapse, we initiated ECMO under dexmedetomidine sedation while preserving spontaneous breathing. In addition to dexmedetomidine, remimazolam then allowed safe, awake intubation and smooth induction of general anesthesia, facilitating controlled mechanical ventilation. V-A ECMO stabilizes the respiratory and circulatory functions, enabling safe, rigid bronchoscopy-guided airway stent placement. This case highlights the feasibility of combining V-A ECMO and remimazolam for high-risk airway management, demonstrating the potential benefits for patients in whom traditional induction techniques are contraindicated. Although limited to a single case, it suggests a potential role of this approach in the perioperative management of difficult airways.