Anaesthetic consequences for a child with complex multilevel airway obstruction -- recommendations for avoiding life-threatening sequelae

A boy with a suspected lymphoid malignancy presented with gross head and neck lymphadenopathy, a middle mediastinal mass, and rapidly worsening airway obstruction. General anaesthesia was required for definitive histopathological diagnosis. The combination of nasopharyngeal obstruction, malignant infiltration of the tonsils and pharynx, laryngeal displacement, and potential tracheal compression put this patient at extreme risk for perioperative airway complications. Risk assessment, and the impact of anaesthesia on pharyngeal neuromechanical function and mediastinal masses are discussed. Caution with volatile anaesthetic agents is recommended in the patient with an inherently unstable pharynx and/or trachea, in whom airway patency relies on a spontaneously breathing technique and intact airway reflexes.