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Congenital tracheomalacia and emergency tracheostomy- a case report.

Background: Tracheomalacia is an abnormal collapse of the tracheal walls. It can be congenital or acquired, isolated or in combination with other lesions. Tracheomalacia is usually benign, with symptoms due to airway obstruction. We want to present a case report of a 2 month old infant with severe respiratory distress due to congenital tracheomalacia. Surgical tracheostomy was needed because of loss of compensatory mechanisms. Case Report: 2 months old F infant, W 4 kg, presented to our department with severe respiratory distress for emergency tracheostomy. She was on 4-6 l HFNF oxygen support, with signs of respiratory failure. Surgical tracheotomy was planned. In the OR, standard anesthesiology monitoring was applied, and 8 l of HFNF humidified heated O2 via nasal prongs, FiO2 40%, 10 min before and during induction, until intubation. Induction was done with fentanyl, midazolam and sevorane (0.8 MAC), further oxygenation via facemask maintaining spontaneous breathing. Infant was intubated with ET 3, 0 ID, ø cuff using VL MAC No 1. eFiO2 before intubation was 94%. Intubation lasted 40 s, no desaturation occurred. Anesthesia was maintained with sevorane (MAC 0.9) in O2/air mixture facilitated with esmeron after securing the ET tube. Ventilation was controlled. After tracheostoma formation tracheal cannula No 3, 5 ø cuff was placed and secured. Proper placement and depth was confirmed with fiber bronchoscope. After the procedure infant was transformed to pediatric ICU and weaned from ventilator 22 h after the procedure, respiratory sufficient without supplemental O2. She was discharged home a month after the tracheotomy. Discussion: HFNF is a method of providing CPAP to children requiring respiratory support. Although, widespread application of HFNF in many hospitals in pediatric wards and ICU, there is an ongoing applicability of HFNF in the ORs for preoxygenation

tracheomalacia, congenital, tracheotomy, HFNC

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