Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2022; 10(26): 9348-9353
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9348
Unexpected difficult airway due to severe upper tracheal distortion: A case report
Jian-Wei Zhou, Chuan-Guang Wang, Gang Chen, You-Fa Zhou, Jia-Feng Ding, Jia-Wei Zhang
Jian-Wei Zhou, Chuan-Guang Wang, Jia-Wei Zhang, Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Gang Chen, You-Fa Zhou, Department of Anesthesia, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
Jia-Feng Ding, Department of Urology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Author contributions: Zhou JW and Wang CG contributed to manuscript writing and editing, and data collection; all authors have read and approved the final manuscript.
Informed consent statement: The patient provided informed consent for the publication of this case report.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
CARE Checklist (2016) statement: The care checklist was uploaded at the time of first submission.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chuan-Guang Wang, BMed, Doctor, MD, MMed, Adjunct Associate Professor, Associate Chief Physician, Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, No. 289 Kuocang Road, Lishui 323000, Zhejiang Province, China. wcg9088@163.com
Received: April 1, 2022
Peer-review started: April 1, 2022
First decision: June 16, 2022
Revised: June 20, 2022
Accepted: August 5, 2022
Article in press: August 5, 2022
Published online: September 16, 2022
Processing time: 153 Days and 19.7 Hours
Abstract
BACKGROUND

Difficult airway is a significant cause of anesthesia-associated death and disability. Currently, physical examinations of thyromental distance, mouth opening, Mafampaii classification, etc. combined with X-ray, computed tomography (CT), and other imaging technologies are mainly used to evaluate difficult airways. However, in many special cases, i.e., emergency surgery, imaging examinations cannot be completed preoperatively. Such patients' airway can only be evaluated through general physical examination, which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.

CASE SUMMARY

We report a rare case of difficult intubation because of severe upper trachea distortion after induction. Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890 μmol/L. Due to the urgency of the condition, chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately, resulting in an unexpected difficult airway.

CONCLUSION

The incidence of tracheal malformation and tracheal stenosis is extremely low, but the risk of hypoxia and even death due to difficult airways is extremely high for such patients. It is recommended to complete preoperative imaging examinations of the airway. For life-threatening emergency patients, a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.

Keywords: Tracheal distortion; Difficult airway; Management; Imaging examination; Emergency

Core Tip: In this paper, we report a case of severe upper tracheal distortion resulting in an unexpectedly difficult airway. The incidence of tracheal malformation and tracheal stenosis is extremely low, but the risk of hypoxia and even death due to difficult airways is extremely high for such patients. It is recommended to complete preoperative imaging examinations of the airway. For life-threatening emergency patients, a pre-anesthesia reassessment should be performed, attention should be paid to bedside physical examination, and surgeons should be prepared to prevent and manage the difficult airway.