• Kui-Rong Wang, Fan-Fan Liu, and Yan-Feng Zhou.
• Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China.
• Medicine (Baltimore). 2019 Jun 1; 98 (26): e16252.

RationaleMassive mediastinal tumors present a major challenge for surgery and anesthesia management due to possible perioperative circulation and respiratory dysfunction.Patient ConcernsA 36-year-old female underwent difficulty with tracheal extubation and required mechanical ventilation for 3 months after resection of a massive mediastinal tumor.DiagnosesPostoperative B-ultrasound examination of diaphragmatic motor weakness and electrophysiological examination indicated respiratory failure due to phrenic nerve injury.InterventionsThe 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.OutcomesThe patient recovered well after tracheotomy and approximately 3 months of ventilation support.LessonsWeaning 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.

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