Anesthetic manipulation in extreme airway stenosis: a case report

Abstract

IntroductionAnesthetic management with airway stenosis is challenging. Techniques for maintaining spontaneous respiration are required under sedative and analgesic conditions.Case presentationA 35-year-old Chinese woman presented to our hospital with difficulty breathing. Computerized tomography showed a tumor in the frontal area of her neck, which was causing extreme narrowing of her trachea. She was immediately scheduled for emergency surgery to remove the tumor. Fiberscopic intubation was carefully performed with dexmedetomidine sedation and remifentanil analgesia. Spontaneous respiration was successfully maintained.ConclusionIn cases of extreme airway stenosis, intubation can be safely achieved with dexmedetomidine sedation and remifentanil analgesia.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

“…224–227,300–303 Case reports also observed successful intubation with flexible intubation scopes (Category B4-B evidence ). 304–356…”

Updates and controversies in anesthesia for advanced interventional pulmonology procedures

“…The authors noted that the amnestic and analgesic properties of dexmedetomidine were particularly helpful in these cases and that 'maintaining spontaneous ventilation with dexmedetomidine as almost the sole anesthetic (off label use) could be very advantageous and may reduce the risk of complete airway obstruction in the anesthetic management of AMMs.' Zhou et al [22] similarly used dexmedetomidine in conjunction with remifentanil to maintain spontaneous respiration during the initial management of a patient with extreme airway stenosis.…”

“…Zhou et al [22] similarly used dexmedetomidine in conjunction with remifentanil to maintain spontaneous respiration during the initial management of a patient with extreme airway stenosis.…”