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KMID : 1155520230180020204
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Anesthesia and Pain Medicine
2023 Volume.18 No. 2 p.204 ~ p.209
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Management of unanticipated difficult airway in a patient with well-visualized vocal cords using video laryngoscopy - A case report -
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Ki Seung-Hee
Cho Seung-Bae
Park Seong-Min
Lee Jeong-Han
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Abstract
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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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KEYWORD
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Airway management, Endotracheal intubation, Laryngostenosis, Stupor, Ventriculoperitoneal shunt
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