title: [A difficult intubation: prolapse of the epiglottis into the trachea in an infant].
abstract: Luxation of the epiglottic cartilage is a very uncommon complication of endotracheal intubation in paediatric anaesthesia. We report on a case of prolapse of the epiglottic cartilage into the trachea in a 4-month-old child who had been anaesthetized for palliative banding of the pulmonary artery and correction of a coarctation of the aorta. Further malformations included a single ventricle combined with an ASD II and VSD. The first intubation (ID 3.5 mm) via the nasopharyngeal route seemed not to involve any problems; breathing pressure, however, increased to 25 cm H2O. Direct laryngoscopy after extubation of the smaller tube and insertion of another one (ID 4.0 mm) demonstrated a completely blocked trachea. The epiglottidean cartilage had prolapsed into the tracheal lumen and excluded any possibility of ventilating the patient. After seizing the epiglottic cartilage with a Magill forceps it was possible to pull the cartilage out of the trachea and to intubate again with the 4.0 mm tube. There were no complications in the postoperative period.
authors.affiliation: Abteilung Anaesthesiologie der Justus-Liebig-Universität Giessen.
authors.forename: M G
authors.initials: MG
authors.lastname: Dehne
authors.forename: C
authors.initials: C
authors.lastname: Knothe
authors.forename: G
authors.initials: G
authors.lastname: Hempelmann
mesh_terms: D004825:Epiglottis; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D011391:Prolapse; D014132:Trachea
vernacular_title: Intubationshindernis: in die Trachea umgeschlagene Epiglottis beim Kleinkind.