[Difficult airway management in a patient with history of tracheotomy]

A 12-year-old girl was scheduled to undergo tympanoplasty. She had received tracheotomy at the age of 10 months. As preoperative bronchofiberscope could reach the glottis with no difficulty, we chose rapid induction. Suddenly after the administration of thiopental, fentanyl and vecuronium bromide, we could not keep mask ventilation. As sniffing position and insertion of airway could not improve difficult ventilation, we intubated quickly. The intubation was easy. We consider that difficult ventilation was not due to upper airway trouble but due to tracheotomy. Muscles around the granuloma were relaxed, and the trachea was closed, just at the height of tracheotomy. We conclude that it may sometimes be difficult in a child with history of tracheotomy to keep mask ventilation.