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Anaesthesia

Title:		Subacute airway obstruction from a tracheal mucosal flap
Author(s):		Farr, M. J. Cyna, A. M.
Address:		Anaesthetic Registrar, Department of Paediatric Anaesthesia, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006.
Year:		2006 Mar
Journal Title:		Anaesthesia
Page Number:		285-90
Language:		eng
Volume:		61
Issue:		3
ISSN/ISBN:		0003-2409 (Print). 0003-2409 (Linking)
Abstract:		We report the case of a 15-year-old girl with a near fatal obstructive tracheal lesion following tracheal intubation. The patient developed stridor and acute respiratory distress 29 h following tracheal extubation, after 35 h intubation in the intensive care unit. The failure of conventional management of stridor, including re-intubation, to provide a satisfactory airway prompted an urgent bronchoscopy, which revealed a tracheal mucosal flap causing 80% obstruction of the subglottic trachea. The fibreoptic bronchoscope allowed careful placement of a tracheal tube distal to the obstruction. The patient eventually made a full recovery. The low incidence of similar lesions and the lack of distinguishing clinical features from other causes of post-extubation stridor make diagnosis and appropriate management of this life-threatening condition difficult. We discuss how early consideration of the diagnosis and optimal initial management reduce the risk of an adverse outcome.