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.
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。