Airway obstruction in general anesthesia--two different episodes in the same patient: case report

The case of a patient with Apert's syndrome (acrocephalosyndactyly) who had a tracheostomy tube and who encountered two different episodes of critical airway obstruction during two different general-anesthetic procedures for craniofacial surgery is reported. The first episode, at the age of four, involved occlusion of the uncuffed tracheostomy tube by a blood clot, which might have come from the surgical field of the maxillary Le-Fort III advancement procedure. The second episode was encountered during his emergence from the general anesthesia of a degloving midface osteoplasty and a maxillary Le-Fort I osteotomy procedure 3 years later. Although a cuffed armored tube had been inserted through the tracheostoma to prevent aspiration of blood from the surgical field, the armored tube was plugged by a piece of granulation tissue that might have been dislodged from the peri-stomal area. Factors that lead to tracheostomy tube obstruction, their clinical features and preventive measures are discussed. We believe that being alert to changes in the airway pressure, the ventilation pattern, and the hemodynamic status is necessary during the administration of general anesthesia. Precautions should be taken at all times, particularly for patients with a tracheostomy.