Two lost airways and one unexpected problem: undiagnosed tracheal stenosis in a morbidly obese patient

Anesthetic care of the morbidly obese is complex due to anatomic and physiologic alterations. Airway management in particular can be challenging. High body mass index is predictive of difficult ventilation and possibly difficult intubation. Other airway anomalies, such as tracheal stenosis, add to the complexity of airway management. Tracheal stenosis, a form of central airway obstruction, may be challenging to diagnose, especially in the obese. Comorbidities can mask the diagnosis and routine imaging may fail to identify the pathology. We present the case of a morbidly obese patient with 2 failed intubations due to difficult anatomy compounded with undiagnosed tracheal stenosis.