Anesthetic consideration for airway management in patient undergoing tracheal resection and reconstruction for severe postintubation tracheal stenosis: a case report

• Published in: Postgraduate medicine 2021-07, Vol.133 (5), p.1-547
• Main Authors: Chen, Yi, Liao, Hong, Niu, Yuanyuan, Ni, Xinli, Wang, Jianzhen
• Format: Article
• Language: English
• ISSN: 0032-5481; 1941-9260
• DOI: 10.1080/00325481.2021.1889849

Severe postintubation tracheal stenosis (PITS) is a rare iatrogenic complication after endotracheal intubation. A case of PITS in a 51-year-old male undergoing partial pericardiectomy with a principal diagnosis of tuberculous constrictive pericarditis. Within 6 hours of extubation, a second emergency intubation lasting 120 hours was performed. The patient reported exertional dyspnea 30 days after discharge. High-resolution tracheobronchial tree computed tomography with three-dimensional reconstruction revealed constriction of the tracheal lumen of more than 80% at the thyroid planar upper third of the trachea. Flexible bronchoscopy revealed a tracheal stenosis located 3-4 cm from the glottis that could not be passed prior to general anesthesia. Mechanical ventilation with a ProSeal laryngeal mask airway (PLMA) and preparation for extracorporeal circulation as a final rescue option were performed to maximize patient safety. The patient underwent a tracheal resection and reconstruction without complications. A supraglottic airway mode may be a practical and worthwhile alternative for patients with severe PITS.