Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic

Abstract

We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance.

Use of the Disposcope endoscope for awake orotracheal intubation in an elderly patient with a large vocal cord polyp -a case report-

“…Most vocal cord polyps are diagnosed and treated in the early stage; however, a small percentage of patients do not seek medical treatment until the polyps have caused dyspnea or begun to significantly affect their lives. Patients with large vocal cord polyps have a high risk of general anesthesia due to difficult intubation [1]. Intubation after the administration of potent sedatives or muscle relaxants may aggravate the airway obstruction caused by the polyp, which can lead to an emergency difficult airway [2].…”