[Acute respiratory failures caused by post-tracheotomy tracheomalacia]

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Respiratory Medicine

Background:

• A 77-year-old male with a history of parapharyngeal tumor removal and tracheotomy presented for thoracic surgery.
• Previous sinus surgery revealed difficult intubation due to tracheal stricture below the tracheotomy scar.

Observation:

• Preoperative assessments were unremarkable, but a sunken, retracted tracheotomy scar and stridor were noted.
• During general anesthesia, intubation was smooth, but extubation led to severe respiratory distress and airway collapse.
• The tracheotomy scar visibly caved in during respiratory distress.

Findings:

• Airway collapse and respiratory failure were attributed to post-tracheotomy tracheomalacia.
• Continuous positive airway pressure via facemask and non-invasive positive pressure ventilation (NPPV) were crucial for respiratory support.

Implications:

• Post-tracheotomy tracheomalacia can lead to life-threatening airway collapse during general anesthesia.
• Careful airway assessment and prompt management with positive pressure ventilation are vital for patients with a history of tracheotomy.
• This case underscores the importance of recognizing and managing dynamic airway collapse in surgical patients.