A breathless journey: airway management in a pregnant patient with non-Hodgkin lymphoma
MyJA 4-1 PDF 83 CR

Categories

How to Cite

Mohd Najid, N. binti, & Mohd Arshad, A. A. (2025). A breathless journey: airway management in a pregnant patient with non-Hodgkin lymphoma. Malaysian Journal of Anaesthesiology, 4(1), 48–54. https://doi.org/10.35119/myja.v4i1.83

Copyright notice

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Copyright (c) 2025 Nazuha binti Mohd Najid, Ahmad Afifi Mohd Arshad

Keywords

difficult airway; non-Hodgkin lymphoma; pregnancy; tracheostomy

Abstract

Airway compromise due to malignancy in pregnancy is rare but presents significant challenges. Physiological changes during pregnancy may further exacerbate airway obstruction from mediastinal masses, complicating management. We report a case requiring early tracheostomy for airway stabilisation and chemotherapy initiation. A 32-year-old at 17 weeks’ gestation presented with non-Hodgkin lymphoma and a large anterior mediastinal mass causing severe airway compression. Multidisciplinary planning prioritised early airway stabilisation to avoid emergent interventions. Awake fibreoptic intubation allowed controlled tracheostomy placement, securing the airway for chemotherapy. Following the third cycle of treatment, the patient showed a good clinical response with significant mass reduction, improved symptoms, and better tolerance of oral intake. Plans were made for elective Caesarean section at 32–34 weeks, with tracheostomy maintained for airway security during delivery. This case underscores the importance of proactive airway management and collaborative planning in pregnancy complicated by mediastinal mass and airway compromise. Early airway stabilisation and multidisciplinary collaboration are critical in managing pregnant patients with compromised airways, thus optimising maternal and foetal outcomes. Future cases with similar risks may benefit from planned airway stabilisation and multidisciplinary collaboration.

https://doi.org/10.35119/myja.v4i1.83
MyJA 4-1 PDF 83 CR

References

Crosby E. Clinical case discussion: anesthesia for Cesarean section in a parturient with a large intrathoracic tumour. Can J Anesth. 2001;48,575–583. https://doi.org/10.1007/BF03016835

Gambling DR, Douglas MJ, Lim G. (Eds.). Uncommon respiratory disorders in pregnancy. In: Obstetric anesthesia and uncommon disorders (3rd ed.) Cambridge University Press; 2024. pp. 89–90

Ho AM-H, Pang E, Wan IPW, Yeung E, Wan S, Mizubuti GB. A Pregnant Patient With a Large Anterior Mediastinal Mass for Thymectomy Requiring One-Lung Anesthesia. Semin Cardiothorac Vasc Anesth. 2020;25(1):34-38. https://doi.org/10.1177/1089253220973133

Boyne IC, O’Connor R, Marsh D. Awake fibreoptic intubation, airway compression and lung collapse in a parturient: anaesthetic and intensive care management. Int J Obstet Anesth. 1999;8(2):138–41. https://doi.org/10.1016/S0959-289X(99)80012-0

Singh K, Balliram S, Ramkissun R. Perioperative anesthesia management of a pregnant patient with central airway obstruction: a case report. Braz J Anesthesiol. 2021;71(3):281-284. doi: 10.1016/j.bjane.2021.02.012

Aissi JS, Guervilly C, Lesouhaitier M. et al. Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study. Crit Care. 2022;26(1):312. https://doi.org/10.1186/s13054-022-04189-5

MyJA 4-1 PDF 83 CR