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Airway obstruction during general anaesthesia in a child with congenital tracheomalacia
1First Department of Anaesthesiology, Dokkyo University School of Medicine, Mibu, Tochigi, 321-0293, Japan.
Insights
Diagnosing tracheomalacia in children requires careful airway management during general anesthesia. This case highlights the risks of airway obstruction when spontaneous breathing returns after fiberoptic bronchoscopy.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Diagnostic Procedures
Background:
- Fiberoptic bronchoscopy is a common diagnostic tool for tracheomalacia, typically performed under local anesthesia.
- General anesthesia may be necessary in pediatric patients due to cooperation challenges.
- Congenital tracheomalacia presents unique airway management difficulties in infants.
Observation:
- A 1-year-old girl with suspected congenital tracheomalacia experienced partial airway obstruction during sevoflurane induction.
- Airway obstruction resolved with vecuronium, allowing laryngeal mask airway use during the procedure.
- Significant airway obstruction recurred upon return of spontaneous ventilation post-procedure.
Findings:
- Tracheomalacia poses significant airway obstruction risks during general anesthesia, particularly during transitions in ventilation.
- Laryngeal mask airway can facilitate bronchoscopy in some tracheomalacia cases but does not eliminate risks.
- Immediate tracheal intubation may be required if obstruction is severe upon resuming spontaneous breathing.
Implications:
- Anesthesiologists must exercise extreme caution when managing airways without tracheal intubation in pediatric tracheomalacia patients.
- Careful monitoring and preparedness for intubation are crucial during fiberoptic bronchoscopy in infants with suspected tracheomalacia.
- Understanding the dynamic airway changes in tracheomalacia is vital for successful anesthetic management.
Abstract:
Fibreoptic bronchoscopy is often used to diagnose tracheomalacia under local anaesthesia. However, in children, general anaesthesia may be required due to difficulty in obtaining co-operation. A 1-yr-old girl with a suspected congenital tracheomalacia was scheduled for diagnostic fibreoptic bronchoscopy. During induction of anaesthesia by inhalation of increasing concentration of sevoflurane, spontaneous breathing became irregular and a partial airway obstruction occurred. Because vecuronium relieved the airway obstruction, the airway was managed using a laryngeal mask. No further airway obstruction occurred during fibrescopy under controlled ventilation, but when spontaneous breathing resumed, marked airway obstruction occurred. The trachea was intubated immediately. Caution is required to manage the airway without tracheal intubation during general anaesthesia in the patient with tracheomalacia.