Department of Anesthesiology.
Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medicine (Baltimore). 2021 Apr 9;100(14):e25455. doi: 10.1097/MD.0000000000025455.
An impacted foreign body (FB) in the larynx of an adult is a rare but potentially life-threatening occurrence. Patients with Down's syndrome (DS) are vulnerable to airway FB. However, the anesthesia for FB removal can be challenging. This report describes a case in which a FB was impacted between the vestibular folds in an adult with DS, congenital heart disease, and a difficult airway.
A 41-year-old woman swallowed a piece of sharp-tipped wooden skewer presented with a sudden onset of aphonia, dysphagia, and an acute sore throat without respiratory difficulty. The patient had DS, congenital heart disease, pulmonary arterial hypertension, and severe obstructive sleep apnea-hypopnea syndrome. The airway evaluation indicated that ventilation and intubation would be difficult due to retrognathia, macroglossia, adenotonsillar hypertrophy, and Mallampati's classification III.
The clinical symptoms and laboratory examination confirmed FB penetrated between the vestibular folds.
After careful multidisciplinary preoperative assessment and preparation, the FB was removed successfully by direct laryngoscopy under moderate sedation and spontaneous ventilation, with the application of 1% lidocaine as topical anesthesia.
The laryngeal FB was removed successfully without any complications. And the patient was discharged home the next day.
This case report shows the importance of anesthetic depth for laryngeal FB removal. The use of moderate sedation (allowing spontaneous ventilation) and adequate analgesia combined with local anesthesia enabled the patient to withstand the stress of direct laryngoscopy. Appropriate assessment, careful preparation, and multidisciplinary collaboration yielded the smooth removal of a laryngeal FB in an adult with DS.
成人喉部异物嵌顿是一种罕见但潜在危及生命的情况。唐氏综合征（DS）患者易发生气道异物。然而，异物取出的麻醉可能具有挑战性。本报告描述了一例 DS 患者、先天性心脏病和困难气道的情况下，FB 嵌顿于杓状软骨间。
一名 41 岁女性吞下一根尖锐的木制烤肉串，突发失音、吞咽困难和急性咽痛，无呼吸困难。该患者患有 DS、先天性心脏病、肺动脉高压和严重阻塞性睡眠呼吸暂停低通气综合征。气道评估表明，由于下颌后缩、巨舌、腺样体扁桃体肥大和 Mallampati 分级 III，通气和插管将很困难。
临床症状和实验室检查证实 FB 穿透杓状软骨间。
经过仔细的多学科术前评估和准备，在中度镇静和自主通气下成功地通过直接喉镜取出 FB，应用 1%利多卡因作为局部麻醉。
成功取出喉部 FB，无任何并发症。患者次日出院回家。
本病例报告表明，麻醉深度对于喉部 FB 取出很重要。中度镇静（允许自主通气）和充分镇痛联合局部麻醉使患者能够承受直接喉镜检查的压力。适当的评估、仔细的准备和多学科合作使 DS 成人喉部 FB 的顺利取出成为可能。
