[Airway management in tracheal stenosis caused by malignant goiter].
We report a case of malignant goiter with severe tracheal stenosis. The patient was a 61-year-old female, who had orthopnea on admission. Radiological examinations revealed a tracheal stenosis extending from 4.5 cm to 8 cm below the glottis; the smallest caliber being 5 mm. On the seventh day after admission, the patient complained of dyspnea even while sitting. An emergency tracheotomy was scheduled. While the patient was awake in a sitting position, a fiberscope was inserted endotracheally to confirm the intact inner surface of the trachea, and then an armored endotracheal tube (outer diameter 9.2 mm, inner diameter 6.5 mm) was inserted. Unexpectedly, the tube could be advanced through the stenosis without resistance. After induction of general anesthesia, the patient was placed in a supine position, and a tracheotomy was performed. This case demonstrates that, while intubation of the trachea through a stenosis is sometimes dangerous, it may be indicated when the inner surface of the trachea is intact and a tube with an inner diameter greater than 5 mm can then be placed.
Mori
Naomi
N
Department of Anesthesia, Kyoto City Hospital, Kyoto 604-8845.
Kitagawa
Sumi
S
Nakamura
Kumi
K
Kitamura
Rie
R
Sumida
Hiroshi
H
Ogino
Yukimasa
Y
D000768:Anesthesia, General; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000150:complications* / Q000601:surgery; D014135:Tracheal Stenosis / Q000209:etiology*; D014140:Tracheotomy