BACKGROUND: It is uncommon to perform liver transplantation for patients with end-stage liver disease having tracheostomy. Usually, the tracheostomy cannula is changed to an oral endotracheal tube (ETT) before operation because ETT is easy to handle during operation. If routine oral ETT insertion is difficult, we should seek other solutions.
METHODS: We report a successful conversion from tracheostomy tube to ETT in a patient with subglottic stenosis. The patient was an 8-month-old infant who was scheduled for living donor liver transplantation due to acute hepatic failure. The original plan was to convert the tracheostomy tube to oral ETT, which failed due to aggravation of subglottic stenosis. An otolaryngologist performed balloon dilatation surgery, and ETT was successfully intubated. Owing to a multidisciplinary approach, the surgery was successfully performed without fatal adverse events, and the patient was later discharged with a tracheostomy.
CONCLUSIONS: It is unusual for pediatric patients with tracheostomy tubes to undergo major surgeries like liver transplantation. We hope that this case of successful anesthetic management based on a multidisciplinary approach suggests new ideas to anesthesiologists seeking safe anesthesia.

OBJECTIVE: Benign (laryngo-)tracheal stenosis is a relatively rare pathology and its surgical treatment is performed only at few specialized centres. This study aims to investigate outcomes after (laryngo-)tracheal resection-anastomosis, to explore potential risk factors for postoperative complications and to assess whether, over a 33-year period, there were major changes in surgical indications, techniques or outcomes.
METHODS: Retrospective, single-centre review of all consecutive patients who underwent tracheal or laryngo-tracheal resection/anastomosis for benign pathologies from 1990 to 2023.
RESULTS: Overall, 211 patients underwent tracheal (149 patients, 70.6%) and laryngo-tracheal (62 patients, 29.4%) resection-anastomosis. Of these, 195 patients (93.8%) were affected by iatrogenic stenosis, while 13 (6.2%) suffered from idiopathic stenosis. The median length of stenosis was 25 mm (interquartile range 1-3, 20-30). The overall morbidity rate was 27.5%, while major morbidity occurred in 10.5% of cases. One patient (0.5%) died in the postoperative period. Glottic oedema (17 patients, 8.1%), granulations (12 patients, 5.7%) and restenosis (10 patients, 4.7%) were the main complications. The only independent risk factor for postoperative complications was the length of the resected airway (P = 0.019). In the latest half of the study period, an older median age was observed, and no patient with idiopathic tracheal stenosis underwent surgery. Postoperative outcomes were comparable between surgical eras.
CONCLUSIONS: Surgical treatment of (laryngo-)tracheal stenosis is challenging and should be performed by specialized centres. In our experience, morbidity and mortality rates were satisfactory, and in most cases, patients could breathe without tracheostomy. The length of the stenosis was the most significant risk factor for postoperative complications.

BACKGROUND: Idiopathic subglottic stenosis is a fibrotic condition of unknown origin that results in blockage of the central airway in the subglottic region. It is widely acknowledged that subglottic stenosis is a relatively uncommon structural anomaly that is difficult to operate on and cure due to its anatomical location. Inguinal hernias are well-established to be prevalent in infants and youngsters. We present a case of subglottic stenosis in a child complicated with an inguinal hernia (IH).
METHODS: A 7-year-old female was admitted to our hospital with a 1-month history of progressive bulging in the left lower quadrant of the abdomen. She complained of no stomach discomfort, distension, or dyspnea, but her family reports that the patient usually wheezes during moderate exertion and has no family history of asthma or lung illness. However, for unclear reasons, the infant experienced shortness of breath following training. A chest CT scan was unremarkable. Below the glottis, a membranous stenosis was discovered. The stenosis beneath the glottis was discovered using dynamic laryngoscopy.
METHODS: Idiopathic subglottic stenosis with an IH.
METHODS: An otorhinolaryngologist employed a carbon dioxide laser to eliminate the subglottic stenosis. Following successful intubation by the anesthesiologist, pediatric surgeons performed laparoscopic high ligation of the hernial sac.
RESULTS: After 1 month, a repeat laryngoscopy revealed significant expansion of the subglottic stenosis, accounting for the improvement in respiratory symptoms.
CONCLUSIONS: The present case raises awareness that surgeons should be more vigilant about respiratory complications in patients with an IH. Early diagnosis and treatment of respiratory illnesses are critical for patients undergoing endotracheal intubation.

This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.
摘要: 本例患者为严重声门下狭窄（Ⅳb级），在实施环气管部分切除术过程中沿着甲状软骨正中下缘及甲状软骨下角下方5 mm之间连线横断环甲膜及环状软骨弓，保留双侧环甲关节，有效保护喉返神经的同时起到了气道的支撑作用，配合合理的术后管理，实现了一期安全拔管。.

Monitoring the oxygenation status is crucial during general anesthesia to ensure patient safety. Although noninvasive pulse oximetry is commonly used to monitor percutaneous oxygen saturation (SpO2), it may not accurately reflect changes in oxygen partial pressure when the latter is excessively high or low. The oxygen reserve index (ORi) provides real-time information about the oxygen reserve status.
We present a case of successful management of subglottic stenosis using balloon bronchoscopy in an infant with a left ventricular assist device implantation under ORi monitoring to predict hypoxemia during the surgical procedure.
Utilizing ORi monitoring during anesthesia for procedures involving apnea in critically ill infants can help predict impending desaturation before a drop in SpO2 occurs, allowing anesthesiologists to effectively anticipate and manage the apnea period. Continuous ORi monitoring offers valuable insights during surgical procedures, especially in infants with compromised respiratory and cardiovascular functions.

患儿女，年龄为10个月3 d，因“误吸发光二极管出现呼吸困难4 h”急诊入院。术前CT提示气管内不规则线状高密度影及尾影，考虑异物可能。术中行支气管镜下异物取出时异物嵌顿于声门下，尝试经口气管镜取出失败，血氧饱和度急剧下降，为保证通气及便于操作将异物推向远端，紧急气管插管后行气管切开，经气管切开处支气管镜下成功取出发光二极管1枚。患儿术后恢复好，随访无并发症。.

本文报道了1例继发性喉气管闭锁的51岁女性患者。患者因“渐进性呼吸不畅、说话费力6个月”入院，入院前因呼吸困难在外院急诊行气管切开术。既往4年前曾因“鼻咽未分化非角化型癌”行放射治疗，定期随访未见复发。入院电子喉镜及颈部CT检查发现喉气管双层面闭锁。患者经反复多次病理活检及全身检查排除恶性肿瘤、特殊感染（结核杆菌、梅毒、真菌）、风湿免疫性疾病后，行喉气管瘢痕松解+喉黏膜瓣显微缝合成型+喉功能重建术。术后5个月，颈段气管二次狭窄处行短T管置入，3个月后拔除T管。随访8个月，患者呼吸顺畅，气道塑形良好。.

The first observation in the world literature of the development of subglottic cysts in the larynx in monochorionic monoamniotic twins is presented. The girls were born prematurely at 34 weeks of gestation, from the first day of life for 7 and 8 days, respectively, were transferred to mechanical ventilation. At the fourth month of life, symptoms of laryngeal stenosis appeared and began to gradually progress, conservative therapy had no effect. The diagnosis of subglottic cysts was established on the basis of fibrolaryngoscopy; after endolaryngeal surgery, breathing returned to normal. This case demonstrates the importance of timely endoscopic examination of the respiratory tract in children with stridor.
Представлено первое в мировой литературе клиническое наблюдение развития подскладковых кист в гортани у монохориальных моноамниотических близнецов. Девочки рождены преждевременно? на 34-й неделе гестации, с первых суток жизни в течение 7 сут и 8 сут соответственно переведены на ИВЛ. На 4-м месяце жизни появились и начали постепенно прогрессировать симптомы стеноза гортани, консервативная терапия эффекта не дала. Диагноз подскладковых кист установлен на основании фиброларингоскопии, после эндоларингеального удаления кист дыхание нормализовалось. Клинический пример демонстрирует важность своевременного эндоскопического осмотра дыхательных путей у детей со стридорозным дыханием.

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.

BACKGROUND: Subglottic tracheal stenosis is stenosis of the trachea between the vocal cords and the lower margin of the cricoid cartilage. The Montgomery T-tube is used as a tracheostomy tube and a combined tracheal stent to avoid postoperative tracheal stenosis.
METHODS: Because the stenosis is close to the glottis, surgical treatment is complex, and many complications may arise.
METHODS: Subglottic tracheal stenosis.
METHODS: The patients underwent endotracheal intubation or tracheotomy because of acute pancreatitis, laryngeal malignancy, or cerebral hemorrhage after endotracheal intubation or tracheotomy and presented with varying degrees of tracheal stenosis and dyspnea. We relieved airway stenosis and improved dyspnea in these 3 patients by placing a Montgomery T-tube.
RESULTS: None of the 3 patients had intraoperative complications. In 2 of the cases, airway secretions were stored after surgery.
CONCLUSIONS: Montgomery T-tube placement is safe and effective for patients with complex subglottic tracheal stenosis.