PDF(Pubmed)
Abstract：
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.
METHODS: 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.
METHODS: 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.
摘要：
背景：困难气道的发生是由于气道的解剖异常，可以通过气道评估来预测；但是，声带以外的异常可能是临床上无症状的，直到插管失败才被发现。
方法：我们介绍了一例未预料到的困难气道的病例，该病例是一名80岁的女性，近期有脑出血和长时间插管史。由于脑积水的进展，她需要进行紧急脑室-腹腔分流手术。在麻醉下,面罩通气很容易，视频喉镜检查提供了声门的完整视图；然而，气管导管（ETT）进入失败。我们怀疑声带狭窄，在急诊手术期间插入并维持较小直径的ETT用于气道管理.术后颈部计算机断层扫描结果显示喉气管狭窄（LTS）。
结论：麻醉医师应意识到LTS可能是无症状的，并考虑对有长时间气管插管史的患者进行困难的气道指南。
方法：我们介绍了一例未预料到的困难气道的病例，该病例是一名80岁的女性，近期有脑出血和长时间插管史。由于脑积水的进展，她需要进行紧急脑室-腹腔分流手术。在麻醉下,面罩通气很容易，视频喉镜检查提供了声门的完整视图；然而，气管导管（ETT）进入失败。我们怀疑声带狭窄，在急诊手术期间插入并维持较小直径的ETT用于气道管理.术后颈部计算机断层扫描结果显示喉气管狭窄（LTS）。
结论：麻醉医师应意识到LTS可能是无症状的，并考虑对有长时间气管插管史的患者进行困难的气道指南。
