Difficulties in tracheal extubation due to phrenic nerve injury during massive mediastinal tumor resection: A case report.

ABSTRACT

RATIONALE Massive mediastinal tumors present a major challenge for surgery and anesthesia management due to possible perioperative circulation and respiratory dysfunction. PATIENT CONCERNS A 36-year-old female underwent difficulty with tracheal extubation and required mechanical ventilation for 3 months after resection of a massive mediastinal tumor. DIAGNOSES Postoperative B-ultrasound examination of diaphragmatic motor weakness and electrophysiological examination indicated respiratory failure due to phrenic nerve injury. INTERVENTIONS: The patient failed tracheal extubation several times after the operation and finally a tracheotomy was performed. Mechanical ventilation, anti-infective treatment, and systemic supportive treatment were provided. OUTCOMES: The patient recovered well after tracheotomy and approximately 3 months of ventilation support. LESSONS Weaning difficulty caused by phrenic nerve injury seriously affected patient postoperative rehabilitation. To reduce the occurrence of similar problems, intraoperative phrenic nerve electrophysiological monitoring should be conducted.