Difficult tracheal intubation and post-extubation airway stenosis in an 11-month-old patient with unrecognized subglottic stenosis: a case report

Abstract

BackgroundSubglottic stenosis can lead to life-threatening difficult tracheal intubation during general anesthesia. We report a case of difficult tracheal intubation in an 11-month-old female who had unrecognized subglottic stenosis.Case presentationThe patient was scheduled for elective correction of a right accessory auricle. She was suspected of having first and second branchial arch syndrome. Preoperative physical examination was normal. Anesthesia was induced uneventfully using sevoflurane. It was not possible to pass size 4.0, 3.5, or 3.0 cuffed endotracheal tubes due to an advanced subglottic lesion. Subsequent successful intubation was achieved using a 3.0 uncuffed tube. Stridor was audible after extubation, and the patient required several days’ treatment with dexamethasone to address respiratory distress.ConclusionsWe encountered unrecognized subglottic stenosis that led to difficult tracheal intubation and post-extubation airway stenosis.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

“…, ankylosing spondylitis, degenerative osteoarthritis, Treacher–Collins, Klippel–Feil, Down syndrome, mucopolysaccharidosis, and airway masses) (Category B4-H evidence ). 71–122…”

Halothane sedation with local anesthesia as a bailout procedure for neonate with subglottic stenosis and post-MMC repair defect for O-Z flap: a case report

“…Approximately 1-2% of intubated neonates, (which can reach up to 11% for children under 5 years of age) might develop subglottic stenosis after endotracheal intubation (1). Patient with mild subglottic stenosis are usually asymptomatic with normal respiratory ndings (2). The patient presented here was considered to have acquired subglottic stenosis.…”