Anaesthetic management of an infant with tracheomalacia scheduled for computed tomography angiography: A challenge

Abstract

Tracheomalacia is characterised by collapse of the tracheal wall with respiration. Computed tomography angiography (CTA) can be utilised for evaluation of airway abnormalities but providing sedation/anaesthesia for CTA in such a case carries the risk of airway catastrophe. We describe the anaesthetic management of an infant who had tracheomalacia with >90% collapse in lower two third of the intrathoracic trachea as diagnosed on videobronchoscpy and was scheduled for CTA.

Epidemiology and Management of Pediatric Tracheomalacia

“…Patients with TM often have non-specific respiratory symptoms, such as loud breathing and a barking cough, respiratory distress episodes, acute life-threatening events, and recurring and/or long-term respiratory infections. [22] Although computed tomography angiography (CTA) can be used to diagnose airway problems, administering sedation or anesthesia for CTA in this situation increases the chance of an airway catastrophe [30]. The most common symptoms of tracheomalacia are dyspnea (at rest or with exertion), cough, sputum retention, wheezing or stridor or both, recurrent pulmonary infection, bronchitis, and cyanotic spells [1,16].…”