Abstract
The elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient's life.
Highlights
Proper management of the difficult airway presents one of the most important skill sets for the anesthesiologist to master
A 45-year-old woman with a long history of tracheal stenosis and upper airway obstruction presented for elective tracheostomy placement in the setting of supra- and infraglottic stenosis after failed awake tracheostomy by an otorhinolaryngologist (ORL) (Figures 1 and 2)
With the failure of what is usually the final step in the algorithm, the anesthesia team in consultation with other surgical specialists opted for venovenous bypass as a means to oxygenate and anesthetize a patient whose airway could not be secured
Summary
The elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient’s life
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