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SummaryTwo patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. In both patients, a single opening in the membrane provided access to both the larynx and oesophagus. Fibreoptic intubation allowed both a thorough assessment of the pathology and subsequently the passage of a cuffed tracheal tube to secure the airway. To overcome the problem of respiratory obstruction while the fibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre-oxygenation and voluntary hyperventilation followed by breath-holding during bronchoscopy , was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes jibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx. Key wordsIntubation, tracheal; fibreoptic. Complications; hypopharyngeal stenosis, rhinoscleroma, caustic burns.Tracheal intubation using the flexible fibreoptic bronchoscope (FFB) is a major advance in the management of difficult intubation [I]. Almost total obliteration of the oropharynx or hypopharynx by cicatricial membranes is an unusual occurrence but it may render conventional laryngoscopy and intubation impossible. Two such cases are presented; in both, fibreoptic intubation helped to overcome the problems in airway management. Case histories Patient IA 20-year-old, 54 kg male presented for evaluation of dysphagia after accidental ingestion of caustic soda 2 years previously. Barium swallow X rays showed delayed passage of barium through the hypopharynx and postcricoid region and diverticula in both piriform fossae. A fibreoptic oesophagogastroscope was introduced orally under topical anaesthesia. As it approached the 12 cm mark, the patient developed severe respiratory obstruction and cyanosis, which resolved as soon as the endoscope was withdrawn. Endoscopic examination revealed a cicatricial membrane extending across the pharynx at the orohypopharyngeal junction, with an elliptical hiatus measuring about 8 mm x 5 mm ( Fig. I(a) and (b)). This aperture provided sole access to the respiratory and alimentary tracts (Figs 2 and 3). It was decided to excise the membrane with a carbon dioxide (CO,) laser, enabling safe endoscopic examination whilst avoiding an otherwise inevitable tracheostomy. General anaesthesia was required. The preanaesthetic examination was unremarkable. Nutrition was well maintained through a feeding gastrostomy. There was no stridor at rest or on exertion.An awake fibreoptic intubation was planned. After explaining the procedure to the patient, the airway was anaesthetised with 4 ml nebulised lignocaine 4%, started 30 min before the procedure. An intravenous infusion was set up and 0.6 mg atropine given intravenously. Electrocardiogram (ECG), heart rate, manual blood pressure, oxygen saturation (Spo,) and end-tidal CO, (~WCO,) were monitored. A 7mm inte...

A 25-year old male patient, with subcarinal mass projecting into carina and lower tracheal lumen underwent carinal resection and reconstruction surgery. This was done through the laryngeal drop and bilateral thoracotomy approach. Intraoperative course was complicated by persistent hypoxia and arrhythmias. This report explores the various anaesthetic issues involved which were effectively managed.

Surgery is one of the curative treatments for patients with tracheobronchial tumours. And endoscopic debridement is one of the palliative therapies for unresectable tumour. Respiratory distress is the commonest complication that can occur in both the procedures. We present the case of 25 year old patient of adenoid cystic carcinoma of lower trachea and left bronchus. He had respiratory distress after induction of anaesthesia which was managed successfully with one lung anaesthesia with single lumen endobronchial tube. It was inoperable tumour and after endobronchial debridement he had episode of tumour embolism to oppossite bronchus causing respiratory distress. This was detected immediately and managed successfully with flexible bronchoscopy.