title: Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor.
abstract: In the event of a high degree of airway obstruction, endotracheal intubation can be impossible and even dangerous, because it can cause complete airway obstruction, especially in patients with high tracheal lesions. However, a smaller endotracheal tube under the guidance of a bronchoscope can be insinuated past obstructive tumor in most noncircumferential cases. Here we report a case of successful fiberoptic bronchoscopy-assisted endotracheal intubation in a patient undergoing surgical resection of a large, high tracheal tumor causing severe tracheal stenosis. A 42-year-old Chinese man presented with dyspnea, intermittent irritable cough, and sleep deprivation for one and a half years. X-rays and computed tomography scan of the chest revealed an irregular pedunculated soft tissue mass within the tracheal lumen. The mass occupied over 90% of the lumen and caused severe tracheal stenosis. Endotracheal intubation was done to perform tracheal tumor resection under general anesthesia. After several failed conventional endotracheal intubation attempts, fiberoptic bronchoscopy-assisted intubation was successful. The patient received mechanical ventilation and then underwent tumor resection and a permanent tracheostomy. This case provides evidence of the usefulness of the fiberoptic bronchoscopy-assisted intubation technique in management of an anticipated difficult airway and suggests that tracheal intubation can be performed directly in patients with a tracheal tumor who can sleep in the supine position, even if they have occasional sleep deprivation and severe tracheal obstruction as revealed by imaging techniques.
authors: Department of Anesthesiology, First Hospital of Jilin University, Changchun, China.
authors: Lei
authors: L
authors: Pang
authors: Yan-Hua
authors: YH
authors: Feng
authors: Hai-Chun
authors: HC
authors: Ma
authors: Su
authors: S
authors: Dong
mesh_terms: D000328:Adult; D001999:Bronchoscopy; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D014057:Tomography, X-Ray Computed; D014134:Tracheal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Difficult airway; Difficulty intubation; Fiberoptic bronchoscopy; Tracheal tumors