Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China.
Department of Anesthesiology, Funing People's Hospital of Jiangsu, Yancheng, Jiangsu Province, China.
Medicine (Baltimore). 2023 Aug 11;102(32):e34536. doi: 10.1097/MD.0000000000034536.
Tracheal diverticulum is a rare airway-related particular occurrence, and the forcible tube insertion may cause tracheal ruptures during tracheotomy. Therefore, fiberoptic bronchoscopy (FOB) should be used routinely on all patients undergoing tracheal intubation or tracheotomy.
A 60-year-old male with laryngeal neoplasms was scheduled for partial laryngectomy using a suspension laryngoscope in July 2020. All operations were performed under general anesthesia through orotracheal intubation. Orotracheal intubation was a noninvasive procedure that could effectively control breathing. At the end of the surgery, the percutaneous tracheostomy was performed to maintain airway patency, facilitate spontaneous respiration, and remove the secretions.
At this moment, the tracheal diverticulum, located at the right posterolateral region of the trachea, became an unexpected airway-related particular occurrence, which led to tracheal tube placement difficulty, mechanical ventilation difficulty, and high airway pressure.
Subsequently, the tracheal tube was repositioned, with placement again confirmed by the FOB.
Tracheal diverticulum is an infrequent cause of tube inserting difficulty for the tracheotomy, and FOB is the first option for patients with catheter placement difficulty and mechanical ventilation difficulty.
气管憩室是一种罕见的气道相关特殊情况，在气管切开时强力插入气管导管可能导致气管破裂。因此，所有接受气管插管或气管切开的患者都应常规使用纤维支气管镜（FOB）。
一位 60 岁男性，患有喉肿瘤，计划于 2020 年 7 月在悬雍垂喉镜下行部分喉切除术。所有手术均在全身麻醉下经口气管插管进行。经口气管插管是一种有效的非侵入性呼吸控制方法。手术结束时，行经皮气管切开术以保持气道通畅，促进自主呼吸和清除分泌物。
此时，气管憩室位于气管右后外侧，成为意料之外的气道相关特殊情况，导致气管导管放置困难、机械通气困难和气道压力升高。
随后重新定位气管导管，并通过 FOB 再次确认放置位置。
气管憩室是气管切开插管困难的罕见原因，对于导管放置困难和机械通气困难的患者，FOB 是首选。
