Anesthetic Management of a Pediatric Patient with Midline Neck Mass Causing Significant Tracheal Compression in Stridor for Resection of Tumor

Abstract

A 1-year-old female child weighing 10 kg, with a mass over the lower part of the neck presented with stridor. Computed tomography showed a solid enhancing lesion in the lower neck causing marked tracheal compression with complete apposition of the anterior and posterior walls of the trachea causing almost complete obliteration of the tracheal lumen. The child was posted for resection of the tumor under general anesthesia. She was induced with sevoflurane 8% in oxygen and intubated following a flexible bronchoscopic assessment with a 4.0 mm cuffed endotracheal tube using C-MAC videolaryngoscope. After positioning, she developed airway compression, and using a fiber-optic bronchoscope, ETT tip was repositioned distal to the area of tracheal compression. There were repeated episodes of airway compression with desaturation intraoperatively. Postoperatively, the child was ventilated. Due to tracheomalacia and bilateral vocal cord palsy, the extubation trials failed, and she was eventually tracheostomized on the 5th postoperative day to maintain airway.