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

Han, Sang Ji; Kim, Cheol Kun; Kwon, Young Eun; Lee, Jun Hak

Case Report

Obstetric Anesthesia

Anesthesia and Pain Medicine 2007;2(4):237-241.
Published online October 30, 2007.

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

Sang Ji Han, Cheol Kun Kim, Young Eun Kwon, Jun Hak Lee

Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea. kwon8373@yahoo.co.kr

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.

Key Words: preeclampsia, subglottic stenosis, tracheal intubation