Unsuspected difficult intubation caused by a laryngeal web

We report a case of unsuspected difficult intubation in an adult caused by laryngeal web formation in the anterior commissure of the larynx. After induction of anaesthesia, most parts of the posterior commissure of the vocal cords were seen clearly at laryngoscopy, but a 7.5-mm internal diameter (id) tracheal tube could not be advanced below the level of the vocal cords because of resistance. Intubation was re- attempted several times after oxygenation by mask with trials of smaller tubes. Finally, a 5.0-mm id cuffed tube was passed successfully through the vocal cords, and secured in place. Because of the unexpected difficulties in intubation, an otolaryngologist was consulted to examine the larynx with a microscope. A web of 0.5 cm in the anterior commissures was found which caused subglottic stenosis.      

Case of unexpected difficult intubation caused by asymptomatic congenital laryngeal web

We report a case of unexpected difficult intubation in a patient with an asymptomatic congenital laryngeal web. A 44-year-old female with left ovarian tumor and endometrial polyp was scheduled for abdominal hysterectomy and left salpingo-oophorectomy under general anesthesia. With aid of laryngoscopy using Macintosh laryngoscope, we attempted to place a tracheal tube (ID 7.5 mm and 7.0 mm), but could not perform instrumentation because of the resistance against the tube just under the vocal cord. We visualized the glottic opening through the Airway Scope and found a membranous lesion at the ventral side of the glottis, diagnosing a congenital laryngeal web. We finally could insert a tracheal tube of ID 6.5 mm into the dorsal side of the glottis. Airway Scope may be a useful device for unexpected difficult tracheal intubation.     

Unexpected difficult intubation

Two cases of asymptomatic epiglottic cysts which presented as partial upper airway obstruction following induction of anaesthesia are described. The incidence, pathology and anaesthetic management are discussed.     

Fastrach laryngeal mask and difficult intubation

OBJECTIVE: To evaluate the success rate of intubation through the intubating laryngeal mask airway (LMA-Fastrach) in patients with predictive signs of difficult airway or after intubation failure. STUDY DESIGN: Open prospective study. PATIENTS: The study included 33 adults, 21 with predictive signs of difficult airway and 12 after intubation failure. METHODS: After induction of anaesthesia, the intubating LMA was inserted. Proper insertion was confirmed by easy bag ventilation and capnography. Intubation through the intubating LMA was then carried out with an armoured endotracheal tube. If intubation failed, a second attempt was carried out after a gentle manipulation of the intubating LMA. After two attempts, if intubation remained impossible, fibrescopic intubation through the intubating LMA was carried out. In case of failure the usual tracheal intubation algorithms were used. RESULTS: Tracheal intubation through the intubating LMA was successful in all patients, in 32 on the first attempt and in one on the second. Successful tracheal intubation was possible on the first attempt in 25 patients (76%), on the second in four (12%) and after fibrescopic intubation through the intubating LMA in the four remaining (12%). CONCLUSION: The results of this study confirm that tracheal intubation through the intubating LMA can be recommended in patients with a difficult airway, whether foreseen or not.     

Anesthesia induction for a difficult intubation infant with a laryngeal cyst

We report a case of difficult airway in a 37-day-old female with a laryngeal cyst during induction of general anesthesia. This case illustrates that upper airway obstruction can occur during induction of anesthesia with an unusual infantile aryepiglottic fold cyst. In this case, successful orotracheal intubation was achieved with spontaneous respiration, and preoperative information on orientation of the lesion assisted in positioning the patient to minimize the degree of dynamic obstruction.     

Usefulness of laryngeal mask for difficult intubation in a child with congenital laryngeal webs

We report a case of difficult intubation with congenital laryngeal web. An 11-year-old boy was scheduled for urinary surgery. After anesthetic induction, the anesthesiologist encountered resistance at the vocal cord preventing satisfactory intubation. A size 3 laryngeal mask was immediately inserted, and an adequate airway was obtained. We found a laryngeal web at the vocal cord by bronchoscope inserted thorough the laryngeal mask. The peroperative course was uneventful. Immediately after removal of the laryngeal mask, the patient developed airway obstruction due to sputum and/or laryngeal spasm. The obstruction was relieved through application of positive pressure ventilation and aspiration of the sputum.     

Unexpected difficult intubation in a patient with normal airway on assessment.

Routine preoperative assessment of the patient's airway includes an assessment of mouth opening and a grading of the view according to the Mallampati scale. This is carried out with the patient sitting and actively opening the mouth without phonation. This case report illustrates that the temporomandibular joint is a complex joint and that certain pathologies may prevent passive depression of the mandible after induction of anaesthesia.     

Unexpected difficult intubation in the patient with Morning Glory syndrome

Morning Glory syndrome is an uncommon congenital optic disc anomaly with occasional systemic associations. A case of unsuspected difficult intubation in a three-year old patient is described in this case report.     

The intubating laryngeal mask Use in failed and difficult intubation

The use of the intubating laryngeal mask in three patients is described. In two patients for whom tracheal intubation using traditional techniques had failed, the intubating laryngeal mask was used to achieve successful tracheal intubation. The trachea of one of these patients was subsequently re-intubated for a second procedure using the same technique. A third patient with a cervical spine fracture whose trachea was electively intubated using the intubating laryngeal mask is also presented.