High-flow nasal cannula combined with intravenous general anesthesia for stent implantation in right lung cancer: A case report

Abstract

Airway blockage frequently occurs in advanced lung cancer patients, leading to breathing difficulties and oxygen deprivation. This severely impacts patients' quality of life and can even result in death. Bronchial stent insertion effectively alleviates these symptoms and is often performed with intravenous general anesthesia. Nevertheless, during anesthesia and the procedure, inadequate ventilation can lead to severe oxygen deficiency and subsequent complications. There is an urgent need for a safe and efficient intraoperative ventilation strategy to maintain sufficient oxygen levels and reduce the risk of oxygen deficiency. We present a case of successful bronchial stent placement using high-flow nasal cannula (HFNC) in conjunction with intravenous general anesthesia. The patient, a 64-year-old male with a one-year history of right peripheral lung cancer, sought treatment for persistent cough and breathing difficulties. Chest X-rays upon admission revealed a substantial increase in the size of the anterior segment of the right upper lung lobe, likely due to peripheral lung cancer complicated by obstructive pneumonia. To address the patient's airway compression symptoms, we proposed "bronchoscopic tracheal stent insertion." The patient exhibited an ejection fraction of 45% on cardiac ultrasound, had limited physical activity tolerance, grade III heart function, severe airway constriction, and maintained oxygen saturation (SPO₂) levels between 85% and 88%. We successfully performed the procedure using HFNC in combination with intravenous general anesthesia, resulting in a significant improvement in airway compression symptoms. In this case, it was found that HFNC could be used as a new non-invasive respiratory support therapy for bronchial stent implantation under intravenous general anesthesia to reduce the occurrence of intraoperative hypoxemia.