Abstract
This is a report of acute epiglottitis seen in a 46-year-old male patient in December 1990. The patient exhibited a slight common cold syndrome, but otherwise he was generally healthy. At 9:30 in the morning, he began playing golf wearing a protective mask in order to avoid cold air inhalation. At about 14:00, he noticed a slight sore throat which developed into a moderate swallowing difficulty at 15:00. Because his phonation function was largely intact, his speech was understandable to his fellow players. He attempted to breathe air with his neck extended because he could not breathe smoothly when he was sitting. At 15:30, he came to our hospital extremely anxious about his condition and he was diagnosed as having croup. A massive dose of corticosteroid was administrated intravenously and epinephrine nebulization was attempted while x-ray films of the neck were being taken (16:00). Then he was diagnosed as having acute epiglottitis but these modalities did not improve his breathing difficulty. Meanwhile, our ENT surgeon decided to perform emergency tracheostomy. Immediately after the patient was transferred to the operating theater (16:15), he became completely choked, developed deep cyanosis and ultimately lost consciousness (16:50). Systolic blood pressure was 40mmHg and heart rate 40 beats per min. Emergency endotracheal intubation was attempted against the swollen larynx. Simultaneously, the ENT surgeon successfully made access to the trachea. That was just before cardiac standstill. Shortly after ventilatilation with ambu-bag, he recovered consciousness. The joint activity of anesthesiologists and ENT surgeons is important in such a clinical situation.
