Unexpected tracheal web encountered during difficult intubation in the operating room

Area of Science:

• Anesthesiology
• Otolaryngology
• Pulmonology

Background:

• Airway management is critical during surgery.
• Previous anterior lumbar interbody fusion can predispose patients to airway complications.
• Difficult intubation presents significant anesthetic challenges.

Purpose of the Study:

• To report a case of difficult intubation due to a tracheal web.
• To highlight the utility of flexible fiberoptic bronchoscopy in diagnosing airway anomalies.
• To demonstrate the successful management of a tracheal web during elective surgery.

Main Methods:

• A 60-year-old female patient requiring revision anterior lumbar interbody fusion.
• Initial attempts at endotracheal intubation failed.
• Ventilation was maintained using an LMA Fastrach.
• Flexible fiberoptic bronchoscopy identified a tracheal web.
• Intraoperative web excision by an otolaryngologist.

Main Results:

• A tracheal web was identified 1 cm below the true vocal cords.
• Excision of the tracheal web was successful.
• Endotracheal tube passage was achieved after web removal.
• The planned surgery was completed successfully.

Conclusions:

• Tracheal webs can cause unexpected difficult intubation.
• Flexible fiberoptic bronchoscopy is essential for diagnosing such airway abnormalities.
• Prompt surgical intervention can resolve tracheal webs, facilitating airway management and surgical continuation.