Difficult intubation and anesthetic management in an adult patient with undiagnosed congenital tracheal stenosis: a case report

Abstract

In the operating room, unanticipated difficult intubation can occur and anesthesiologists can experience challenging situations. Undiagnosed tracheal stenosis caused by congenital factors, trauma, tumors, or post-intubation injury, can make advancing the endotracheal tube difficult. We present an adult patient in whom we were unable to pass an endotracheal tube into the trachea. This was caused by undiagnosed congenital mid-tracheal stenosis with complete tracheal rings. When faced with an unanticipated difficult airway, the anesthesiologist needs to comprehend the results of preoperative evaluations. If an unusual situation (e.g., congenital tracheal stenosis) occurs, active cooperation with other departments should be considered.

Successful airway management with combined use of a McGRATHTM MAC videolaryngoscope and fiberoptic bronchoscope in a patient with congenital tracheal stenosis diagnosed in adulthood

“…CTS remaining undiagnosed until adulthood is extremely rare. A literature search identified 16 CTS patients diagnosed at the age of 20 years or older [ 3 – 18 ]. Table 1 shows the summary of the 17 patients, including the present case.…”

“…Seven patients had no respiratory symptoms [ 5 – 8 , 10 , 17 , 18 ]. Among the 10 patients with respiratory symptoms, five patients had asthma-like symptoms [ 9 , 13 , 14 , 16 ].…”

“…Thus, there might be undiagnosed CTS patients among adult patients with prolonged refractory bronchial asthma. Pulmonary function test results were described in six cases [ 3 – 5 , 11 , 14 , 18 ]. The flow-volume curve was consistent with an upper airway obstruction pattern in five patients [ 3 – 5 , 11 , 14 ], decreased %FEV 1.0 was reported in two patients [ 3 , 5 ], and decreased peak expiratory flow was reported in three patients [ 3 , 5 , 14 ].…”

“…The flow-volume curve was consistent with an upper airway obstruction pattern in five patients [ 3 – 5 , 11 , 14 ], decreased %FEV 1.0 was reported in two patients [ 3 , 5 ], and decreased peak expiratory flow was reported in three patients [ 3 , 5 , 14 ]. Ten of the 17 patients underwent surgery [ 3 , 5 – 8 , 10 , 15 , 17 , 18 ]. The airway was secured by tracheal intubation in seven patients [ 3 , 5 – 7 , 15 , 18 ].…”

“…Ten of the 17 patients underwent surgery [ 3 , 5 – 8 , 10 , 15 , 17 , 18 ]. The airway was secured by tracheal intubation in seven patients [ 3 , 5 – 7 , 15 , 18 ]. Due to the failure in tracheal intubation, airway was secured using a laryngeal mask airway in two patients [ 10 , 17 ], and emergency tracheostomy was performed in the remaining patient [ 8 ].…”