Emergency Retrograde Endotracheal Intubation in a Child with Sublingual Teratoma and Congenital Tracheal Stenosis / 대한마취과학회지

ABSTRACT

Because of failure to intubate 2-year-old male patient suffering from respiratory difficulty due to sublingual mass (teratoma), emergent tracheostomy was planned. During induction with 100% oxygen and halothane with face mask, sudden cardiopulmonary arrest was occured. Circulation was resuscitated promptly but airway was not kept due to difficult intubation. So ventilation was proceeded through 16 gauge angiocatheter by cricothyroid membrane puncture and retrograde intubation was carried out with epidural catheter through another cricothyroid membrane puncture after then tracheostomy and removal of teratoma was carried out without event. But the patient has had severe dyspnea frequently in postoperative period. On postoperative 7th day, funnel shaped congenital tracheal stenosis was found with bronchogram. Therefore, we concluded that the post-tracheostomy respiratory problem was due to congenital tracheal stenosis. In conclusion, retrograde intubation is a valuable alternative for the emergent unexpected difficult intubation for adults or children because it has a high success rate, easy to learn, requires little practice and does not require complex apparatus. And the failure of a suitable tube to insert the trachea after it passed through the vocal cords or continuous dyspnea after intubation or tracheostomy be considered as the presence of airway narrowing and, possibly, congenital tracheal stenosis.