Pereira Dulce, Cruz Ana S, Dias Luís, Gomes Cristina
Anesthesiology, Centro Hospitalar de Tondela-Viseu, Viseu, PRT.
Anesthesiology, Hospital de Braga, Braga, PRT.
Cureus. 2024 Jun 12;16(6):e62250. doi: 10.7759/cureus.62250. eCollection 2024 Jun.
Subglottic stenosis is characterized by the narrowing of the airway at the inferior edge of the cricoid cartilage level. It is either congenital or acquired, the latter being more commonly secondary to internal iatrogenic trauma. Airway management of these cases is challenging and requires multidisciplinary discussion. We present a case of a 17-year-old boy scheduled for tracheostomy in the context of subglottic stenosis probably caused by prolonged endotracheal intubation. On the day of surgery, it was decided to perform an asleep fiberoptic visualization of the lesion through a supraglottic device, which revealed a narrow circumferential fibrous membrane just below the vocal cords. Given the findings, a suspension laryngoscopy accompanied by supraglottic manual jet ventilation was performed. Balloon dilatation with the application of mitomycin C was the elected otorhinolaryngologic technique. At the end of the procedure, a fiberoptic exam was performed and only a minimal portion of the membrane remained. The patient was asymptomatic on follow-up visits. We aim to raise awareness of how the anesthetic management of patients with subglottic stenosis may prove challenging. Communication between anesthetic and surgical teams is essential for the achievement of the main goal, which is the acquisition of an adequate airway that allows normal patient activity associated with minimal postoperative morbidity.
声门下狭窄的特征是环状软骨水平下缘处气道变窄。它可分为先天性或后天性，后者更常见于医源性内部创伤。这些病例的气道管理具有挑战性，需要多学科讨论。我们报告一例17岁男孩，因可能由长期气管插管导致的声门下狭窄而计划行气管造口术。手术当天，决定通过声门上装置对病变进行清醒状态下的纤维喉镜检查，结果显示声带下方有一圈狭窄的纤维膜。鉴于检查结果，进行了悬吊喉镜检查并辅以声门上手动喷射通气。选用的耳鼻喉科技术是应用丝裂霉素C进行球囊扩张。手术结束时，进行了纤维喉镜检查，仅残留极小部分的膜。患者在随访中无症状。我们旨在提高对声门下狭窄患者麻醉管理可能具有挑战性的认识。麻醉团队与手术团队之间的沟通对于实现主要目标至关重要，即获得一个足够的气道，使患者能够正常活动且术后发病率降至最低。
