Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

Abstract

Management of a “difficult airway” remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a “difficult airway” and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and techniques to avoid complications and fatality.

Iatrogenic Tracheal Stenosis Presenting as Persistent Asthma

“…The onset of stenosis usually ranges from 2-24 weeks following ex-tubation, 5 but the incidence increases with the duration of intubation, and tracheal stenosis is rare when intubation was Ͻ 1 week. 6 Whited found a 12% incidence of laryngeal stenosis in patients who were intubated for Ն 11 days, a 5% incidence following 6 -10 days of intubation, and a 2% incidence with Ͻ 6 days of intubation. 7 To our knowledge, only 3 cases of post-intubation tracheal stenosis have been reported with intubation of Ͻ 48 hours.…”

Avoiding misdiagnosis in patients with dyspnea and wheezing: a case report illustrating the clinical implications of fixation error

“…Despite the technological improvements and more skillful patient care in intensive care units, the most common benign cause of tracheal stenosis in the adult population is post-intubation laryngotracheal stenosis [ 9 ]. Our patient had a history of elective surgery (cholecystectomy); however the latter was performed 5 years before, whilst stenosis after surgery usually develops in 2 to 24 weeks after extubation [ 10 ]. Among rarer causes of tracheal lumen narrowing due to extrinsic compression are thyroid pathologies, vascular anomalies, or mediastinal lymphadenopathies, whilst intrinsic narrowing is more commonly a consequence of malignancy, tracheomalacia, granulomatosis with polyangiitis, or chronic inflammatory diseases (e.g., sarcoidosis).…”

Nasopharyngeal Symptoms caused by Abnormal Inflation of the Endotracheal Tube in Patients undergoing Cervical Spine Surgery

“…Frequent adverse effects: infection, haemorrhage, aspiration, subcutaneous emphysema, laryngeal granulomas, pneumothorax, pneumomediastinum, atelectasis, laryngeal edema, laryngeal ulceration, laryngeal granulomas, laryngeal and tracheal stenosis and tracheomalacia, and infrequent adverse effects: cricoarytenoid subluxation, cricoarytenoid scars, vocal cord paralysis, tracheal necrosis, tracheal rupture, paratracheal abscesses, tracheoesophageal and traqueovascular fistulas (7,(9)(10).…”