Anesth Pain Med.  2007 Oct;2(4):237-241.

Unanticipated Difficult Intubation in a Preeclamptic Parturient with Asymptomatic Subglottic Stenosis Caused by Unknown Origin : A case report

• Han SJ
• Kim CK
• Kwon YE
• Lee JH

Abstract

Subglottic stenosis can be caused by various etiology such as idiopathic, infectious disease, trauma from previous prolonged intubation, airway surgery, external blunt trauma, radiaton, or inhalation burn. Although extremely rare, subglottic stenosis may be present in pregnancy and engender a complex and technically challenging dilemma for anesthesiologist as how to evaluate and best manage these patients. A 36-year-old parturient was scheduled for Cesarean section. When most of the vocal cords were exposed clearly by laryngoscopy after injection of thiopental sodium & succinylcholine, the 7.0 mm internal diameter (ID) endotracheal tube could not be advanced below the level of the vocal cords because of resistance. So, intubation was re-attempted several times after oxygenation by mask with smaller tubes. Finally, a 6.0 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. We present an unexpected case of the difficult endotracheal intubation caused by a unrecognized subglottic stenosis in a preeclamptic who underwent the induction of general anesthesia for Cesarean section.

Keyword

preeclampsia; subglottic stenosis; tracheal intubation

MeSH Terms

Adult
Anesthesia, General
Burns, Inhalation
Cesarean Section
Communicable Diseases
Constriction, Pathologic*
Female
Humans
Intubation*
Intubation, Intratracheal
Laryngoscopy
Larynx
Masks
Oxygen
Pre-Eclampsia
Pregnancy
Succinylcholine
Thiopental
Vocal Cords
Oxygen
Succinylcholine
Thiopental