Our Unpredicted Difficult Airway Experience in Tracheobronchopathia Osteochondroplastica Patient: A Case Report

Abstract

Difficult airway is a serious condition that can be fatal and is frequently encountered during general anesthesia applications. Tracheobronkopathy osteochondroplasty (TBO) is a rare benign disease that is one of the causes of unpredictable difficult airway. A 45-year-old male patient with no comorbidities was transferred to the operating room for elective cholecystectomy. He couldn’t be intubated after standard monitoring and induction of anesthesia. The patient, who had papillomatous lesions in the trachea detected by bronchoscopy, was awakened to be scheduled for rigid bronchoscopy. TBO was detected in pathological examination of the samples taken in rigid bronchoscopy. TBO is a rare benign disease. Its etiology is unknown. It may be asymptomatic or may present with persistent dry cough, hemoptysis, dyspnea, recurrent lower respiratory tract infection, atelectasis and difficult intubation. Some patients may be diagnosed for the first time in the operating room due to difficult intubation.In cases with advanced tracheal stenosis, invasive airway intervention may be required or it may have a fatal course. The use of a laryngeal mask in the perioperative period may be an ideal option in a patient known to have TBO before. Unexpected difficult airway management in the operating room is important for anesthesiologists. According to the difficult airway society algorithm, waking the patient from a planned operation is the safest way until the problem is detected. We did not need invasive intervention because our patient also had elective surgery and ventilation was not difficult. In addition, we think that it is an important decision to make a diagnosis using fiberobtic bronchoscopy in operating room conditions and to wake up our patient with sugammadex without repeated attemps of tracheal intubation and delay elective surgery. In coclusion, it should be kept in mind that TBO may be one of the unpredictable causes of difficult intubation in the operating room.

Keywords

• traceobroncopatia osteocondroplastica
• difficult airway
• fiberobtic broncoscopy