Ir J Med Sci DOI 10.1007/s11845-014-1131-2
LETTER TO THE EDITOR
Laryngeal subglottic web in a parturient G. Basaranoglu • T. Umutoglu • M. Bakan B. Veyseller • Z. Salihoglu
•
Received: 14 April 2014 / Accepted: 28 April 2014 Ó Royal Academy of Medicine in Ireland 2014
Editor, We report a difficult intubation due to laryngeal subglottic web caused by laryngopharyngeal reflux disease. The patient gave a written consent to publish this report. A 40-year-old woman was scheduled for emergency caesarean section (C/S) delivery at 36th gestational week due to placenta previa. At preoperative examination she had history of gastroesophageal reflux disease (GERD) for 5 years and she had chronic cough and heartburn for 2 years. Previously, she had two C/S and tonsillectomy under general anaesthesia. Her Mallampati score was 3, thyromental distance was 10 cm and sternomental distance was 15 cm. Mouth opening was 6 cm and atlanto-occipital extension was 75°. Her laboratory tests were within normal ranges. The patient refused neuraxial anaesthesia. Following preoxygenation, anaesthesia induction was facilitated with propofol 2 mg/kg, lidocaine 1 mg/kg, and rocuronium
G. Basaranoglu (&) T. Umutoglu M. Bakan Z. Salihoglu Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Fatih, Vatan cad, 34093 Istanbul, Turkey e-mail: [email protected] T. Umutoglu e-mail: [email protected] M. Bakan e-mail: [email protected] Z. Salihoglu e-mail: [email protected] B. Veyseller Department of Ear Nose Throat Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey e-mail: [email protected]
bromide 0.5 mg/kg. General anaesthesia was maintained with sevoflurane 2 in 50 % air/oxygen mixture. Laryngoscopic view was grade 4 according to Cormach-Lehane and improved to grade 2 after cricoid pressure. Intubation attempts with 7.0 and 6.0 internal diameter (ID) endotracheal tubes failed, and patient was intubated with 5.0 ID cuffed tube at the third attempt. Operative period was uneventful and patient was discharged to service ward after successful extubation. On the second postoperative day, otolaryngological examination revealed pachydermia at the posterior glottic zone and anterior-located crescent-shaped subglottic laryngeal web (Fig. 1). Laryngeal webs may be congenital or acquired and consist of thin transparent or thick fibrous membranes [1]. The aetiology of acquired laryngeal webs is not precisely illuminated; however, it has strong relations with laryngopharyngeal reflux disease, vocal abuse or smoking and can be a consequence of surgical procedures, intubation, or infections [2, 3]. Recent reports show that GERD may cause laryngopharyngeal symptoms. The incidence of GERD in patients with laryngopharyngeal symptoms is greater than expected [3]. Pregnant individuals have an eightfold risk of difficult intubation rates compared to normal population [4]. Concomitant pathologies of the airway structures could increase the risk and may be life-threatening during anaesthesia induction. Symptoms like chronic cough, heartburn and hoarseness might be related to laryngeal web. In conclusion, patients suffering from symptoms related to laryngeal web must be kept in mind, and trachea of the patient should not be enforced and smaller size endotracheal tubes should be preferred.
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Ir J Med Sci
References 1. Chong ZK, Jawan B, Poon YY, Lee JH (1997) Unsuspected difficult intubation caused by a laryngeal web. Br J Anaesth 79:396–397 2. Nicollas R, Triglia JM (2008) The anterior laryngeal webs. Otolaryngol Clin North Am 4:877–888 3. Rouev P, Chakarski I, Doskov D, Dimov G, Staykova E (2005) Laryngopharyngeal symptoms and gastroesophageal reflux disease. J Voice 19:476–480 4. Boutonnet M, Faitot V, Keı¨ta H (2011) Airway management in obstetrics. Ann Fr Anesth Reanim 30:651–664 Fig. 1 Pachydermia at the posterior glottic zone and anterior-located crescent-shaped subglottic laryngeal web
Conflict of interest
123
None declared.
LETTER TO THE EDITOR
Laryngeal subglottic web in a parturient G. Basaranoglu • T. Umutoglu • M. Bakan B. Veyseller • Z. Salihoglu
•
Received: 14 April 2014 / Accepted: 28 April 2014 Ó Royal Academy of Medicine in Ireland 2014
Editor, We report a difficult intubation due to laryngeal subglottic web caused by laryngopharyngeal reflux disease. The patient gave a written consent to publish this report. A 40-year-old woman was scheduled for emergency caesarean section (C/S) delivery at 36th gestational week due to placenta previa. At preoperative examination she had history of gastroesophageal reflux disease (GERD) for 5 years and she had chronic cough and heartburn for 2 years. Previously, she had two C/S and tonsillectomy under general anaesthesia. Her Mallampati score was 3, thyromental distance was 10 cm and sternomental distance was 15 cm. Mouth opening was 6 cm and atlanto-occipital extension was 75°. Her laboratory tests were within normal ranges. The patient refused neuraxial anaesthesia. Following preoxygenation, anaesthesia induction was facilitated with propofol 2 mg/kg, lidocaine 1 mg/kg, and rocuronium
G. Basaranoglu (&) T. Umutoglu M. Bakan Z. Salihoglu Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Fatih, Vatan cad, 34093 Istanbul, Turkey e-mail: [email protected] T. Umutoglu e-mail: [email protected] M. Bakan e-mail: [email protected] Z. Salihoglu e-mail: [email protected] B. Veyseller Department of Ear Nose Throat Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey e-mail: [email protected]
bromide 0.5 mg/kg. General anaesthesia was maintained with sevoflurane 2 in 50 % air/oxygen mixture. Laryngoscopic view was grade 4 according to Cormach-Lehane and improved to grade 2 after cricoid pressure. Intubation attempts with 7.0 and 6.0 internal diameter (ID) endotracheal tubes failed, and patient was intubated with 5.0 ID cuffed tube at the third attempt. Operative period was uneventful and patient was discharged to service ward after successful extubation. On the second postoperative day, otolaryngological examination revealed pachydermia at the posterior glottic zone and anterior-located crescent-shaped subglottic laryngeal web (Fig. 1). Laryngeal webs may be congenital or acquired and consist of thin transparent or thick fibrous membranes [1]. The aetiology of acquired laryngeal webs is not precisely illuminated; however, it has strong relations with laryngopharyngeal reflux disease, vocal abuse or smoking and can be a consequence of surgical procedures, intubation, or infections [2, 3]. Recent reports show that GERD may cause laryngopharyngeal symptoms. The incidence of GERD in patients with laryngopharyngeal symptoms is greater than expected [3]. Pregnant individuals have an eightfold risk of difficult intubation rates compared to normal population [4]. Concomitant pathologies of the airway structures could increase the risk and may be life-threatening during anaesthesia induction. Symptoms like chronic cough, heartburn and hoarseness might be related to laryngeal web. In conclusion, patients suffering from symptoms related to laryngeal web must be kept in mind, and trachea of the patient should not be enforced and smaller size endotracheal tubes should be preferred.
123
Ir J Med Sci
References 1. Chong ZK, Jawan B, Poon YY, Lee JH (1997) Unsuspected difficult intubation caused by a laryngeal web. Br J Anaesth 79:396–397 2. Nicollas R, Triglia JM (2008) The anterior laryngeal webs. Otolaryngol Clin North Am 4:877–888 3. Rouev P, Chakarski I, Doskov D, Dimov G, Staykova E (2005) Laryngopharyngeal symptoms and gastroesophageal reflux disease. J Voice 19:476–480 4. Boutonnet M, Faitot V, Keı¨ta H (2011) Airway management in obstetrics. Ann Fr Anesth Reanim 30:651–664 Fig. 1 Pachydermia at the posterior glottic zone and anterior-located crescent-shaped subglottic laryngeal web
Conflict of interest
123
None declared.
