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

ABSTRACT

Introduction Severe postintubation tracheal stenosis (PITS) is a rare iatrogenic complication after endotracheal intubation.

Case presentation 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.

Conclusion A supraglottic airway mode may be a practical and worthwhile alternative for patients with severe PITS.

KEYWORDS:

• Airway management
• tracheal resection and reconstruction
• postintubation tracheal stenosis
• case report

Acknowledgments

We wish to thank Heather L. McConnell, from the Houston Methodist Hospital, for her help in editing this manuscript.

Declaration of financial/other relationships

The authors have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

Peer reviewers on this manuscript have received an honorarium from Postgraduate Medicine for their review work but have no other relevant financial relationships to disclose.

Ethical statement

This report was approved by the local Medical Ethics Committee (No. KYLL-2020-6). Written informed consent was obtained from the patient for publication of this report and any accompanying images.

Declaration of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by the funding project of Ningxia Medical University Fund for Scientific Research (no. XM2020145)