Para pharyngeal Tumor with Airway Obstruction Choosing an Alternate Airway

Mohanty A, Anusha B, Krishna Prasad T and Dilip Kumar G

Published on: 2024-09-09

Abstract

A multi-lumen catheter guide has made the process of retrograde tracheal intubation easier. It would effortlessly follow the retrograde guide when utilized as an anterograde guide, guiding the endotracheal tube's insertion in an atraumatic manner. In order to prevent the endotracheal tube from dislodging from the laryngeal inlet, a novel approach is presented that enables stabilization of the anterograde catheter and its implantation deep inside the trachea.

In need of surgical resection was a 72-year-old man with a body mass index of 20.3 who had a pleomorphic adenoma extending into para pharyngeal space in the jaw that extended to the oropharynx and rhino pharynx. After consulting with the general surgery department and analyzing the imaging in computed tomographic (CT), our team decided to use a modified retrograde intubation to control the airway. The team's proficiency and skill with the procedure, the patient's prompt availability, and the tolerance of the percutaneous wire were some of the factors that led to the decision to proceed with retrograde intubation under moderate sedation. After discussing the possibilities with the patient, they decided to move forward. The patient was put to a supine position, with the head turned comfortably position of the patient, then slightly elevated to 15 degrees and the neck slightly extended, under standard monitoring. Using a target-controlled infusion pump, a combination of dexmedetomidine and fentanyl infusion was given intravenously to provide a moderate sedation that preserved spontaneous breathing. The nostrils were anesthetized by inserting a gauze soaked in lignocaine mixed with 1:200,000 epinephrine to improve comfort and reduce the likelihood of bleeding. Following the identification and imaging of features using ultrasound and anatomy, including the assessment of the thyroid isthmus and surrounding blood vessels, a 27-G needle was used to administer Lidocaine 2% transtracheally, a local anesthetic, between the first and second tracheal rings [1].