Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen
Primary intratracheal masses causing luminal obstruction are relatively rare, posing a challenge for anaesthesiologists in airway management. This case report describes a distinctive airway management approach in a 71-year-old female patient with an aorta-carotid artery bypass graft that significant...
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| Format: | Article |
| Language: | English |
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Galenos Publishing House
2024-10-01
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| Series: | Turkish Journal of Anaesthesiology and Reanimation |
| Subjects: | |
| Online Access: | https://turkjanaesthesiolreanim.org/articles/anaesthesia-management-of-a-patient-with-airway-obstruction-caused-by-prosthetic-vascular-graft-invasion-into-the-tracheal-lumen/doi/TJAR.2024.241627 |
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| author | Serdar Demirgan Gülçin Karacan Sezen Kumaş Solak Burcu Akyüz Hakkıcan Akpolat Ayşin Selcan |
| author_facet | Serdar Demirgan Gülçin Karacan Sezen Kumaş Solak Burcu Akyüz Hakkıcan Akpolat Ayşin Selcan |
| author_sort | Serdar Demirgan |
| collection | DOAJ |
| description | Primary intratracheal masses causing luminal obstruction are relatively rare, posing a challenge for anaesthesiologists in airway management. This case report describes a distinctive airway management approach in a 71-year-old female patient with an aorta-carotid artery bypass graft that significantly obstructed the trachea.
The patient presented with worsening shortness of breath, and a thoracic computed tomography scan revealed a 19.2 mm×9.9 mm×19.3 contrast-enhancing mass penetrating the right anterolateral tracheal wall, resulting in 80% occlusion of the tracheal lumen. Awake fiberoptic bronchoscopy (FOB)-guided nasotracheal intubation was performed following topical upper airway anaesthesia, with the patient positioned at a 30º head-up angle and slight right-up tilt to minimize discomfort. A 6.0 mm ID cuffed endotracheal tube was successfully placed under fiberoptic guidance distal to the intratracheal vascular graft but proximal to the carina. Intratracheal masses can lead to severe tracheal obstruction followed by progressive airway obstruction, which can be life-threatening when effective ventilation cannot be established after the induction of general anaesthesia. We recommend the use of awake FOB-guided intubation in such cases. Additionally, contingency plans should be prepared and meticulously prepared in the event of intubation or ventilation failure. |
| format | Article |
| id | doaj-art-cd0a5140969b4c1d95b9f31c467847f7 |
| institution | Kabale University |
| issn | 2667-6370 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Galenos Publishing House |
| record_format | Article |
| series | Turkish Journal of Anaesthesiology and Reanimation |
| spelling | doaj-art-cd0a5140969b4c1d95b9f31c467847f72024-11-11T06:29:12ZengGalenos Publishing HouseTurkish Journal of Anaesthesiology and Reanimation2667-63702024-10-0152519619910.4274/TJAR.2024.241627Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal LumenSerdar Demirgan0https://orcid.org/0000-0001-8129-5004Gülçin Karacan1https://orcid.org/0000-0003-0063-5455Sezen Kumaş Solak2https://orcid.org/0000-0002-9856-6269Burcu Akyüz3https://orcid.org/0009-0007-0822-3873Hakkıcan Akpolat4https://orcid.org/0000-0002-3896-3609Ayşin Selcan5https://orcid.org/0000-0001-6464-4188University of Health Sciences Turkey, Bağcılar Training and Research Hospital, Clinic of Anaesthesiology İstanbul, TurkeyUniversity of Health Sciences Turkey, Bağcılar Training and Research Hospital, Clinic of Anaesthesiology İstanbul, TurkeyUniversity of Health Sciences Turkey, Bağcılar Training and Research Hospital, Clinic of Anaesthesiology İstanbul, TurkeyUniversity of Health Sciences Turkey, Bağcılar Training and Research Hospital, Clinic of Anaesthesiology İstanbul, TurkeyUniversity of Health Sciences Turkey, Bağcılar Training and Research Hospital, Clinic of Anaesthesiology İstanbul, TurkeyUniversity of Health Sciences Turkey, Bağcılar Training and Research Hospital, Clinic of Anaesthesiology İstanbul, TurkeyPrimary intratracheal masses causing luminal obstruction are relatively rare, posing a challenge for anaesthesiologists in airway management. This case report describes a distinctive airway management approach in a 71-year-old female patient with an aorta-carotid artery bypass graft that significantly obstructed the trachea. The patient presented with worsening shortness of breath, and a thoracic computed tomography scan revealed a 19.2 mm×9.9 mm×19.3 contrast-enhancing mass penetrating the right anterolateral tracheal wall, resulting in 80% occlusion of the tracheal lumen. Awake fiberoptic bronchoscopy (FOB)-guided nasotracheal intubation was performed following topical upper airway anaesthesia, with the patient positioned at a 30º head-up angle and slight right-up tilt to minimize discomfort. A 6.0 mm ID cuffed endotracheal tube was successfully placed under fiberoptic guidance distal to the intratracheal vascular graft but proximal to the carina. Intratracheal masses can lead to severe tracheal obstruction followed by progressive airway obstruction, which can be life-threatening when effective ventilation cannot be established after the induction of general anaesthesia. We recommend the use of awake FOB-guided intubation in such cases. Additionally, contingency plans should be prepared and meticulously prepared in the event of intubation or ventilation failure.https://turkjanaesthesiolreanim.org/articles/anaesthesia-management-of-a-patient-with-airway-obstruction-caused-by-prosthetic-vascular-graft-invasion-into-the-tracheal-lumen/doi/TJAR.2024.241627anaesthetic managementbronchoscopydifficult airwayprosthetic vascular grafttracheal obstruction |
| spellingShingle | Serdar Demirgan Gülçin Karacan Sezen Kumaş Solak Burcu Akyüz Hakkıcan Akpolat Ayşin Selcan Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen Turkish Journal of Anaesthesiology and Reanimation anaesthetic management bronchoscopy difficult airway prosthetic vascular graft tracheal obstruction |
| title | Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen |
| title_full | Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen |
| title_fullStr | Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen |
| title_full_unstemmed | Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen |
| title_short | Anaesthesia Management of A Patient with Airway Obstruction Caused by Prosthetic Vascular Graft Invasion into the Tracheal Lumen |
| title_sort | anaesthesia management of a patient with airway obstruction caused by prosthetic vascular graft invasion into the tracheal lumen |
| topic | anaesthetic management bronchoscopy difficult airway prosthetic vascular graft tracheal obstruction |
| url | https://turkjanaesthesiolreanim.org/articles/anaesthesia-management-of-a-patient-with-airway-obstruction-caused-by-prosthetic-vascular-graft-invasion-into-the-tracheal-lumen/doi/TJAR.2024.241627 |
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