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Airway obstruction in a child with asymptomatic tracheobronchomalacia

  • Takashi Asai
  • Koh Shingu
Obstetrical and Pediatric Anesthesia

Abstract

Purpose

To report a case of airway obstruction with hypoxia during emergence from anesthesia due to unexpected tracheobronchomalacia in a child.

Clinical features

In a previously healthy 22-month-old boy with no symptoms or signs of respiratory disease, general anesthesia was induced by inhalation of increasing concentrations of sevoflurane (up to 5%) in oxygen and a laryngeal mask was inserted. Partial airway obstruction persisted during surgery, but obstruction was relieved by positive-pressure ventilation. During emergence from anesthesia, airway obstruction with hypoxia occurred, necessitating tracheal intubation. Emission of carbon dioxide as well as of sevoflurane was reduced and emergence from anesthesia markedly delayed. Fibreoptic tracheoscopy showed marked collapse of the tracheobronchi during expiration, and a diagnosis of tracheobronchomalacia was made. No respiratory complications occurred postoperatively.

Conclusion

Asymptomatic tracheomalacia should also be suspected in case of airway obstruction during anesthesia in young children.

Keywords

Sevoflurane Airway Obstruction Tracheal Intubation Spontaneous Breathing Tracheal Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Obstruction des voies aériennes chez un enfant atteint de trachéobronchomalacie asymptomatique

Résumé

Objectif

Présenter un cas d’obstruction des voies aériennes avec hypoxie, survenue pendant le retour à la conscience et causée par une trachéobronchomalacie inattendue chez un enfant.

Éléments cliniques

Chez un enfant de 22 mois, auparavant en bonne santé, qui ne présentait aucun signe ou symptôme d’affection respiratoire, on a induit l’anesthésie générale par l’inhalation de concentrations croissantes de sévoflurane (jusqu’à 5%) dans de l’oxygène et mis en place un masque laryngé. L’obstruction partielle des voies aériennes a persisté pendant l’intervention chirurgicale, mais a été soulagée par la ventilation à pression positive. Pendant le retour à la conscience, l’obstruction des voies aériennes accompagnée d’hypoxie ont nécessité une intubation endotrachéale. L’expiration de gaz carbonique, et du sévoflurane, a été réduite et le réveil retardé de façon marquée. La fibroscopie trachéoscopique a montré un important affaissement trachéobronchique pendant l’expiration, suggérant une trachéobronchomalacie. Il n’y a eu aucune complication respiratoire postopératoire.

Conclusion

La trachéomalacie asymptomatique devrait être envisagée en cas d’obstruction des voies aériennes pendant l’anesthésie de jeunes enfants.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  1. 1.Department of AnesthesiologyKansai Medical UniversityOsakaJapan

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