Intraoperative Airway Obstruction: A Case Report

Intraoperative airway obstruction due to acute intratracheal hemorrhage represents a rare yet life-threatening anesthetic emergency requiring immediate recognition and urgent intervention for critical airway obstruction. We present the case of a 66-year-old male with extensive medical comorbidities undergoing rib plating for traumatic fractures, who experienced sudden absence of end-tidal CO₂ and bloody secretions following elective exchange from a single-lumen to a double-lumen endotracheal tube. Emergent bronchoscopy identified extensive obstructing tracheobronchial blood clots. Initial management with a supraglottic airway provided temporary oxygenation but proved insufficient for clot removal. Definitive airway clearance required intervention involving rigid bronchoscopy with optical forceps and cryoextraction. Subsequent imaging and ENT evaluation identified minor mucosal trauma as the likely bleeding source, exacerbated by the patient's underlying coagulopathy. Following controlled airway management and intensive care monitoring, the patient was successfully extubated and recovered fully without further complications.