2023 Volume 51 Issue 2 Pages 30-32
We report a case in which tracheal stenosis was incidentally found during endotracheal intubation in a patient receiving general anesthesia for dental treatment.
A 19-year-old woman with Down syndrome was scheduled to undergo dental treatment under general anesthesia because of multiple dental caries. The patient had undergone a patent ductus arteriosus repair at the age of 18 months.
General anesthesia was initiated by a slow induction, and endotracheal intubation was attempted using a tracheal spiral tube with an inner diameter (I. D.) of 7.0 mm and an outer diameter (O. D.) of 9.7 mm. Resistance was encountered while attempting to advance the endotracheal tube. Subsequent observation of the inside of the trachea using an endoscope revealed an apparent tracheal stenosis, which was thought to have been the cause of the resistance. The tracheal tube was changed to one with an I. D. of 5.0 mm (O. D., 6.9 mm), and the endotracheal intubation was completed. Normal artificial respiration was obtained, and the operation was completed without any complications. Prior to a subsequent second general anesthesia, we performed a 3D chest computed tomography (CT) examination to evaluate the morphology of the tracheal stenosis, and we selected a strategy that would enable airway management without advancing an endotracheal tube through the stenotic area.
Tracheal stenosis without clinical symptoms can be detected incidentally during intubation under general anesthesia. As patients with Down syndrome are more likely to have tracheal stenosis, careful attention is needed when performing endotracheal intubation.
