Management of unanticipated difficult airway in a patient with well-visualized vocal cords using video laryngoscopy - A case report

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. We present a case of an unanti...

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Bibliographic Details
Published in:Anesthesia and pain medicine (Korean society of anesthesiologists) 2023-04, Vol.18 (2), p.204-209
Main Authors: Ki, Seunghee, Cho, Seung Bae, Park, Seongmin, Lee, Jeonghan
Format: Article
Language:English
Subjects:
Airway Management
endotracheal intubation
laryngostenosis
stupor
ventriculoperitoneal shunt
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Summary: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. 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). Anesthesiologists should be aware that LTS may be asymptomatic and consider difficult airway guidelines in patients with history of prolonged endotracheal intubation.
ISSN:1975-5171
2383-7977
DOI:10.17085/apm.23002