One lung ventilation management in a patient with Reinke's edema

Reinke's edema (RE) is a benign laryngeal disease. We describe the case of a patient with history of bilateral RE requiring surgical treatment, that came to our attention for a lung lobectomy due to adenocarcinoma. In consideration of the possible complications at the time of extubation and of the probable difficult control of the airways, the patient underwent intervention of microflap surgery for the RE at the same time of lobectomy. We opted for Bronchial Blocker (BB) using a Viva-sight™ Single Lumen Tube (SLT) Internal Diameter (ID) 7.0 mm (Ambu A/S, Baltorpbakken 13, DK-2750 Ballerup, Denmark) with integrated high-resolution camera.

The patient (female, 67 years old, BMI 28) was a candidate for lung lobectomy. She reported a RE requiring surgical treatment. An armoured Endo Tracheal Tube (ETT) ID 5.0 mm was positioned and microflap surgery was performed. Once this surgery ended, the armoured ETT was removed after placing an airway guide wire exchanger and a SLT ID 7.0 mm was placed. ​VivaSight-endoblocher™ (EB) was positioned in the right bronchus.

We opted for double intervention, the risk that could result from the delay persuaded the patient to perform surgery for the RE. Postponing the lobectomy was dangerous for the oncological situation. The Viva-Sight SLT represented the right compromise.

Even after the microflap, the space available for the ETT was reduced and, in order not to traumatize a tissue already stressed by surgery and to facilitate the tracheal intubation, we opted for BB using a Viva-sight™.