Management of unanticipated difficult airway in a patient with well-visualized vocal cords using video laryngoscopy - A case report.

Seunghee Ki, Seung Bae Cho, Seongmin Park, Jeonghan Lee
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Abstract

Background: Difficult airway occurs due to anatomical abnormalities of the airway that can be predicted through airway assessments; however, abnormalities beyond the vocal cord can be clinically asymptomatic and undetected until intubation failure to advance the endotracheal tube.

Case: We present a case of an unanticipated difficult airway in a stuporous 80-year-old female with a recent history of intracerebral hemorrhage and prolonged intubation. She required emergency ventriculo-peritoneal shunt surgery due to the progression of her hydrocephalus. Under anesthesia, facemask ventilation was easy and video laryngoscopy provided a full view of the glottis; however, endotracheal tube (ETT) entry failed. We suspected stenosis beyond the vocal cord, and a smaller diameter ETT was inserted and maintained for airway management during emergency surgery. Postoperative neck computed tomography findings revealed laryngotracheal stenosis (LTS).

Conclusions: Anesthesiologists should be aware that LTS may be asymptomatic and consider difficult airway guidelines in patients with history of prolonged endotracheal intubation.

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视像喉镜下处理声带清晰患者意外气道困难1例。
背景:气道困难是由于气道的解剖异常引起的,可以通过气道评估来预测;然而,声带以外的异常可能在临床上无症状且未被发现,直到插管失败推进气管内管。病例:我们提出一个病例的一个意想不到的困难气道昏迷80岁的女性与近期的脑出血史和延长插管。由于脑积水的进展,她需要紧急脑室-腹膜分流手术。麻醉下,面罩通气容易,视频喉镜提供声门的完整视图;然而,气管内插管失败。我们怀疑狭窄超出了声带,并在急诊手术中插入并维持较小直径的ETT用于气道管理。术后颈部电脑断层显示喉气管狭窄(LTS)。结论:麻醉师应该意识到LTS可能是无症状的,并考虑对有长时间气管插管史的患者进行困难的气道指导。
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