Kurwe Mahesh S, Karim Habib Md Reazaul, Mehta Rupa, Nene Yogesh
Anaesthesiology and Critical Care, All India Institute of Medical Sciences Raipur, Raipur, India.
ENT Head and Neck Surgery, All India Institute of Medical Sciences Raipur, Raipur, India.
Turk J Anaesthesiol Reanim. 2021 Apr;49(2):175-177. doi: 10.5152/TJAR.2021.64. Epub 2021 Apr 1.
Dynamic airway obstruction is a terrifying situation. Most of the time, the obstruction is intermittent. The situation becomes horrifying and panicky when this intermittent dynamic airway obstruction turns into a total laryngeal obstruction under anaesthesia. Herein, we present a case of a 56-year-old male with vocal cord polyp, who was posted for excision. The difficult airway was anticipated in view of a thick neck. He was also hypertensive and a suggestive case of obstructive sleep apnoea. The patient went to the cannot ventilate, cannot intubate, cannot oxygenate situation because of the polyp taking position between the vocal cords and completely obstructing the central airway gateway. The case was successfully managed by emergency cricothyroidotomy by following the Vortex approach but taught us a few lessons. The case shows us the relevance of clinical findings and the importance of vocal polyp as a cause of inducible laryngeal obstruction and highlights the consequences of intuition and minor lacuna in airway management.
动态气道梗阻是一种可怕的情况。大多数时候，梗阻是间歇性的。当这种间歇性动态气道梗阻在麻醉下转变为完全性喉梗阻时，情况就变得可怕且令人恐慌。在此，我们报告一例56岁男性声带息肉患者，计划进行息肉切除。鉴于患者颈部较粗，预计气道管理困难。他还患有高血压，且疑似阻塞性睡眠呼吸暂停。由于息肉位于声带之间并完全阻塞中央气道入口，患者陷入了无法通气、无法插管、无法给氧的困境。通过采用Vortex方法进行紧急环甲膜切开术，该病例得以成功处理，但也给我们带来了一些教训。该病例向我们展示了临床发现的相关性以及声带息肉作为可诱导性喉梗阻原因的重要性，并凸显了气道管理中直觉和小失误的后果。
