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[A cause of intubation failure: a subglottic bridge]
O Giraud1, A Lienhard, J B Nottet
1Département d'anesthésie-réanimation chirurgicale, hôpital d'instruction des Armées Percy, Clamart, France.
Annales Francaises D'Anesthesie Et De Reanimation
|September 29, 1998
Summary
Prolonged intubation can cause subglottic stenosis, obstructing tracheal intubation. A laryngeal mask provided ventilation, and surgical resection of the laryngeal band resolved the issue.
Area of Science:
- Anesthesiology
- Otolaryngology
- Critical Care Medicine
Background:
- Patients with extensive burn injuries often require prolonged mechanical ventilation via endotracheal intubation.
- Previous intubation can lead to complications such as subglottic stenosis, presenting challenges for future airway management.
- This case highlights a specific instance of subglottic obstruction following burn treatment.
Observation:
- A patient with a history of facio-thoracic burns and prolonged intubation presented with an inability to intubate the trachea due to a subglottic obstacle.
- Ventilation was successfully managed using a laryngeal mask during surgery for postburn cheloids.
- Laryngoscopy revealed a transverse subglottic laryngeal band, likely a sequela of prior prolonged intubation.
Findings:
- Subglottic laryngeal bands can form as a complication of prolonged endotracheal intubation.
- Conventional indicators for difficult intubation may not identify such laryngotracheal obstacles.
- Laryngeal mask ventilation offers a viable alternative when tracheal intubation is challenging.
Implications:
- Awareness of potential subglottic stenosis is crucial in patients with a history of prolonged intubation.
- Laryngeal mask airway (LMA) use should be considered in cases of anticipated or encountered difficult tracheal intubation.
- Prompt diagnosis and surgical intervention can effectively manage subglottic airway obstruction.