Tracheal intubation in a patient with undetectable tracheal narrowing on chest radiography

Hakumoto, Yoko; Takasugi, Yoshihiro; Kamamoto, Hiromichi; Shigemori, Sae; Koga, Yoshihisa; Mori, Kazuhiko

doi:10.1007/s00540-009-0841-5

Cited by 5 publications

(2 citation statements)

References 11 publications

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“…Safe airway management is a predisposition for every surgery requiring endotracheal intubation. Any kind of malformation of the trachea can be challenging for an anesthesiologist, especially if unrecognized before entering the operating room [9]. Standard preoperative imaging, if not required differently, generally includes only a chest X-ray, but tracheal malformations may not always be apparent, as in this case.…”

Section: Discussionmentioning

confidence: 98%

Saber-sheath trachea as a challenge for safe surgery: A case report

et al. 2019

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Introduction. Saber-sheath trachea is a rare malformation of the trachea marked with coronal narrowing with concomitant widening of sagittal diameter, with a sagittal-to-coronal diameter ratio exceeding 2:1. As tracheal rings are stiff and do not collapse around the tube, the intubation is difficult. Case Report. A 53-year-old female was referred to our hospital due to failed intubation at the local hospital during a planned surgery of skin melanoma. The patient was scheduled for surgery in our hospital, her case was presented to a panel of anesthesiologists and she was prepared for surgery. The intubation failed again, even though a video-assisted laryngoscope and endotracheal tube with 5 mm internal diameter was used. The anesthesiologist noticed that the endotracheal tube entered the trachea only 2 cm due to strong resistance, so further intubation was not an option in order to avoid damaging the trachea. The surgery was performed in local anesthesia with analgosedation. Later on, computed tomography was done, because of suspected pathological process compressing trachea, but the radiologist described the anomaly as saber-sheath trachea. One year later, the patient presented with axillary lymph node metastases and needed another surgery. This time the anesthesiologist knew about the trachea malformation, anticipated difficult intubation and used i-gel TM for airway management. Conclusion. Despite the fact that numerous methods have been developed for the purpose of identifying patients at risk of difficult intubation, there are many unexpected airway pathologies that can lead to failed intubation. Adequate preoperative assessment, knowledge of Guidelines for Difficult Intubation Management, availability of supraglottic airway devices, and cooperation between the surgeon and anesthesiologist, are crucial to successful patient management.

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Section: Discussionmentioning

confidence: 98%

Saber-sheath trachea as a challenge for safe surgery: A case report

et al. 2019

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“…As an alternative way of airway evaluation, video laryngoscopy has a broader view, but may induce a more potent stimulus than fibroscopy. During active bleeding of supraglottic tumor, video laryngoscopy is suggested ( 15 ). On severe pharyngeal edema while difficult tracheal intubation was anticipated, it was reported that intubation through an air-Q intubating laryngeal airway successfully secured ventilation with preserved spontaneous breathing ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Airway Management During Anesthetic Induction of Secondary Laryngectomy for Recurrent Laryngeal Cancer: Three Cases of Report and Analysis

et al. 2018

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Surgery for laryngeal cancer and the following recurrent tumor growth may further change the anatomy of the airway. Airway management during anesthesia induction is challenging for the patients undergoing secondary surgery due to recurrence of laryngeal cancer or its postoperative complication, but it has never been reported. In this report, we described three cases of anesthetic induction which had different process of airway events. The first case was given intravenous general anesthetic for induction and experienced failed intubation, difficult mask ventilation and emergent tracheostomy, eventually were rescued successfully. The second case presented a fixed metastatic mass about 6 cm diameter upon the primary surgical scar of incision and preoperative apnea, underwent fibroscopy-guided conscious intubation and the process was uneventful. The third case had erythema and swelling under the mandible with erupted ulcer as well as neck immobility due to recurrent tumor. The anesthesiologist attempted fibroscopy-guided intubation via nasal passage with a tracheal tube in 2.8 mm diameter but it was failed. Subsequently, tracheostomy was performed under bilateral superficial cervical plexus block and the dissected larynx by operation verified distorted structure of glottis with S-shaped stenosis. This report concludes that, during the anesthetic induction for this special type of surgery, a detailed and comprehensive evaluation of the airway, and a routine fibroscopic examination are especially important.

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Utility of three-dimensional computed tomography in general thoracic surgery

Akiba

2013

Gen Thorac Cardiovasc Surg

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It is important for general thoracic surgeons to understand the relationship between tumors and surrounding organs during surgery; however, many anatomical variations are possible in the thorax, which can complicate this goal. Multidetector computed tomography (MDCT) is the latest technical breakthrough in CT imaging. MDCT permits rapid scanning of large areas of the body with multiple detectors, thereby allowing for simultaneous acquisition of an increased number of transaxial CT slices, which reduce motion artifacts. Three-dimensional (3D) rendering involves the creation of two-dimensional images that convey the 3D relationship of objects. The 3D reconstruction allows for enormous quantity of data to be utilized intuitively and effectively. The final images can reveal various lesions or organs of interest with high anatomical detail and accuracy to the general thoracic surgeon, which is helpful in performing safer surgeries. Surgeries for the following can benefit from this technology: lung lobectomy or segmentectomy, pulmonary sequestration, cardiovascular malformation, tracheobronchial tree, mediastinum, and chest wall. This article reviews the utility of 3D-MDCT imaging in the field of general thoracic surgery.

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Tracheal intubation in a patient with undetectable tracheal narrowing on chest radiography

Cited by 5 publications

References 11 publications

Saber-sheath trachea as a challenge for safe surgery: A case report

Saber-sheath trachea as a challenge for safe surgery: A case report

Airway Management During Anesthetic Induction of Secondary Laryngectomy for Recurrent Laryngeal Cancer: Three Cases of Report and Analysis

Utility of three-dimensional computed tomography in general thoracic surgery

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