Unexpected Tracheal Web Encountered During Difficult Intubation in the Operating Room

Abstract

A 60-year-old woman was prepared for revision of a previous anterior lumbar interbody fusion. After induction of anesthesia, three attempts to pass decreasing sizes of endotracheal tubes remained unsuccessful. An LMA Fastrach was inserted to maintain ventilation. Upon examination of the trachea with a flexible fiberoptic bronchoscope via the LMA Fastrach, a tracheal web was visualized 1 cm below the true vocal cords. Intraoperative excision of the tracheal web by an otolaryngologist allowed for the passage of an endotracheal tube and the continuation of the planned surgery.

Unsuspected tracheal web inhibits endotracheal intubation: report of a case

“…In adults, tracheal webs are known as a late complication after endotracheal intubation and after tracheostomy [1,2], and are characterized as rare [3,4]. Tracheal webs have been described in children at an incidence of 1 in 10 000 births [3,4].…”

“…Tracheal webs have been described in children at an incidence of 1 in 10 000 births [3,4]. The incidence of tracheal webs in adults is unknown.…”

Tracheal Web

“…Those patients were reported to have unexpected difficulty during intubation while undergoing an operation for an unrelated reason. [4][5][6] However, most of the patients with webs presented with symptoms including frequent episodes of respiratory infections, dyspnea on exertion, wheezing, stridor, severe respiratory distress, and even death depending on the size of the obstructed area caused by valve-manner motion of these lesions. 3,7,8 According to Desle´e et al, 8 delay from extubation to first symptoms varied between 14 hours and 9 days, with an average of about 29 hours.…”

An unusual case of wheeze

“…Tracheal webs are very rare1 (incidence 1:10 000 births1 2) and can mimic asthma 1 2. They consist of a thin layer of tissue draped across the tracheal lumen 3.…”

“…They consist of a thin layer of tissue draped across the tracheal lumen 3. They may be asymptomatic or more commonly present with biphasic stridor, wheeze, cough and dyspnoea 2 3. Diagnosis is confirmed by bronchoscopy 1 3.…”