Hybrid Airway Management for Neuromonitoring-guided Selective Phrenic Nerve Surgery in Intractable Hiccups: A Case Report
- 1University of Health Sciences Türkiye, Gaziantep City Hospital, Clinic of Anaesthesiology and Reanimation, Gaziantep, Türkiye
- 2University of Health Sciences Türkiye, Gaziantep City Hospital, Clinic of Thoracic Surgery, Gaziantep, Türkiye
Abstract
Intractable hiccups are rare but debilitating, and may cause sleep disturbances, nutritional impairment, exhaustion, and a severe deterioration in quality of life. When pharmacological and interventional treatments fail, selected surgical procedures targeting the phrenic nerve may be considered. We report the anaesthetic management of a 32-year-old woman with idiopathic intractable hiccups who underwent right-sided selective phrenic nerve surgery guided by thoracoscopic neuromonitoring. Because thoracoscopic exposure and intraoperative neuromonitoring were required simultaneously, a hybrid airway strategy combining an electromyography endotracheal tube with a bronchial blocker was used. The patient was positioned in the left lateral decubitus position, and the bronchial blocker was placed in the right main bronchus under fiberoptic bronchoscopic guidance. One-lung ventilation was maintained for 35 minutes with FiO2 of 0.70 to 0.80, tidal volume of 5-6 mL kg-1, respiratory rate of 18 min-1, and PEEP of 5 cmH2O; the arterial blood gas analysis at 25 minutes showed pH 7.38, PaCO2 41 mmHg, and PaO2 92 mmHg. Sugammadex was administered intraoperatively to restore diaphragmatic motor responses required for branch-specific neuromonitoring. The medial and anterolateral branches of the right phrenic nerve exhibited abnormal electrophysiological responses and were treated with selective bipolar ablation and clipping. Postoperatively, the patient remained on room air, reported no intraoperative recall, and showed no clinically relevant diaphragmatic dysfunction on clinical and functional assessment. This case illustrates that established anaesthetic techniques can be carefully adapted to meet the competing requirements of lung isolation, anaesthetic depth control, and neuromonitoring in selected patients undergoing phrenic nerve surgery for intractable hiccups.
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BibTeX
@article{kurkcuoglu2026hybrid,
title = {{Hybrid Airway Management for Neuromonitoring-guided Selective Phrenic Nerve Surgery in Intractable Hiccups: A Case Report}},
author = {Bekir Suat Kürkçüoğlu and Sinan Ünsal and Bahar Uslu Bayhan and Tuğçe Gazioğlu Kişi and Onur Bayrakçı},
journal = {Turkish Journal of Anaesthesiology and Reanimation},
year = {2026},
month = oct,
doi = {10.4274/tjar.2026.262496},
url = {https://doi.org/10.4274/tjar.2026.262496},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Hybrid Airway Management for Neuromonitoring-guided Selective Phrenic Nerve Surgery in Intractable Hiccups: A Case Report
AU - Bekir Suat Kürkçüoğlu
AU - Sinan Ünsal
AU - Bahar Uslu Bayhan
AU - Tuğçe Gazioğlu Kişi
AU - Onur Bayrakçı
PY - 2026
DA - 2026/10/30
JO - Turkish Journal of Anaesthesiology and Reanimation
DO - 10.4274/tjar.2026.262496
UR - https://doi.org/10.4274/tjar.2026.262496
AB - Intractable hiccups are rare but debilitating, and may cause sleep disturbances, nutritional impairment, exhaustion, and a severe deterioration in quality of life. When pharmacological and interventional treatments fail, selected surgical procedures targeting the phrenic nerve may be considered. We report the anaesthetic management of a 32-year-old woman with idiopathic intractable hiccups who underwent right-sided selective phrenic nerve surgery guided by thoracoscopic neuromonitoring. Because thoracoscopic exposure and intraoperative neuromonitoring were required simultaneously, a hybrid airway strategy combining an electromyography endotracheal tube with a bronchial blocker was used. The patient was positioned in the left lateral decubitus position, and the bronchial blocker was placed in the right main bronchus under fiberoptic bronchoscopic guidance. One-lung ventilation was maintained for 35 minutes with FiO2 of 0.70 to 0.80, tidal volume of 5-6 mL kg-1, respiratory rate of 18 min-1, and PEEP of 5 cmH2O; the arterial blood gas analysis at 25 minutes showed pH 7.38, PaCO2 41 mmHg, and PaO2 92 mmHg. Sugammadex was administered intraoperatively to restore diaphragmatic motor responses required for branch-specific neuromonitoring. The medial and anterolateral branches of the right phrenic nerve exhibited abnormal electrophysiological responses and were treated with selective bipolar ablation and clipping. Postoperatively, the patient remained on room air, reported no intraoperative recall, and showed no clinically relevant diaphragmatic dysfunction on clinical and functional assessment. This case illustrates that established anaesthetic techniques can be carefully adapted to meet the competing requirements of lung isolation, anaesthetic depth control, and neuromonitoring in selected patients undergoing phrenic nerve surgery for intractable hiccups.
SN - 2667-677X
SN - 2667-6370
ER -