Koh Chooi Lin, Lim Sandy, Chua Andy Jian Kai, Alsuwaigh Rayan, Chan Chi Ho
Department of Anaesthesiology, Sengkang General Hospital, Singapore, SGP.
Department of Otorhinolaryngology, Sengkang General Hospital, Singapore, SGP.
Cureus. 2025 Jun 23;17(6):e86578. doi: 10.7759/cureus.86578. eCollection 2025 Jun.
Tracheal stenosis is a rare condition that poses significant challenges in airway management. We report a case of failed emergency awake fiberoptic intubation necessitating difficult front-of-neck access in a patient with respiratory failure, tracheal stenosis, and an in situ tracheal stent. The patient presented to the emergency department with acute respiratory distress and was urgently transferred to the operating theatre for emergent intubation. An awake intubation technique was attempted; however, the patient deteriorated during airway topicalization, necessitating rescue airway maneuvers. Bag-valve-mask ventilation proved difficult, and an attempt to insert a Portex™ size 6 endotracheal tube (Smiths Medical, Minneapolis, MN, USA) was unsuccessful due to resistance encountered after passing the vocal cords. An emergent tracheostomy was performed, but was complicated by the presence of the tracheal stent. Ultimately, a Shiley™ cuffless size 4 tube (Medtronic, Mansfield, MA, USA) was successfully inserted. Bronchoscopic assessment revealed granulation tissue both proximal and distal to the tracheal stent, with near-complete obstruction of the left main bronchus, accounting for the intubation resistance and ventilatory difficulties. The silicone tracheal stent remained in place with no signs of migration post-intubation. This case underscores the complexities of airway management in critical tracheal stenosis secondary to granulation tissue with an in situ tracheal stent.
气管狭窄是一种罕见疾病，在气道管理方面带来重大挑战。我们报告一例紧急清醒纤维支气管镜插管失败的病例，该患者呼吸衰竭、气管狭窄且气管内有原位支架，需要进行困难的颈部前方入路操作。患者因急性呼吸窘迫就诊于急诊科，随后紧急转至手术室进行紧急插管。尝试了清醒插管技术；然而，在气道局部麻醉过程中患者病情恶化，需要进行挽救气道的操作。球囊面罩通气困难，试图插入一根美国明尼阿波利斯市史密斯医疗公司生产的6号Portex™气管内导管时，在通过声带后遇到阻力，插管未成功。紧急进行了气管切开术，但因气管支架的存在而出现并发症。最终，成功插入了一根美国马萨诸塞州曼斯菲尔德市美敦力公司生产的4号无套囊Shiley™导管。支气管镜评估显示气管支架近端和远端均有肉芽组织，左主支气管近乎完全阻塞，这就是插管阻力和通气困难的原因。插管后，硅胶气管支架仍留在原位，无移位迹象。该病例突显了在伴有原位气管支架的肉芽组织导致的严重气管狭窄中气道管理的复杂性。
