Unexpected difficult tracheal intubation secondary to subglottic stenosis leading to emergency front‐of‐neck airway. Issue 1 (9th May 2021)

• Record Type: Journal Article
• Authors: Ellis, H.; Iliff, H. A.; Lahloub, F. M. F.; Smith, D. R. K.; Rees, G. J.
• Is Part Of: Anaesthesia reports. Volume 9:Issue 1(2021)
• Page Start: 90
• Page End: 94
• Publication Date: 2021-05-09
• Subjects: difficult airway algorithm -- hypercapnia: causes -- intubation; Anesthesiology -- Periodicals; 617.9605
• DOI: 10.1002/anr3.12115
• Languages: English
• ISSNs: 2637-3726

Abstract

Summary: A 26‐year‐old woman presenting for an elective day case procedure under general anaesthesia had undiagnosed subglottic stenosis leading to a life threatening airway emergency requiring emergency front‐of‐neck airway. We outline the case and discuss key anaesthetic considerations in subglottic stenosis, including concerning features of a medical/anaesthetic history and the potential for rapid deterioration of a stenotic airway following manipulation. We also consider the effect of anaesthesia on the calibre of subglottic stenosis and the effects of positive pressure ventilation. Subglottic stenosis is a rare condition with congenital, acquired and idiopathic origins; however, iatrogenic trauma is the most common cause. We are aware of a small number of published case reports of previously undiagnosed subglottic stenosis in adults discovered after induction of anaesthesia; situational deterioration to 'cannot intubate, cannot oxygenate' scenarios appear even rarer.