Airway obstruction by extrinsic tracheal compression during spinal surgery under prone position -A case report-

Abstract

Tracheal compression by vascular anomalies in adults is uncommon and most related reports are of children. A 79-year-old woman without any respiratory history underwent a lumbar spine surgery under general anesthesia. She suddenly developed airway obstruction after a position change from supine to prone. A fiberoptic bronchoscopy showed the obstruction of endotracheal tube. The obstruction was relieved after we changed the depth of endotracheal tube and supported the patient's neck with a cotton roll. The surgery ended without any other event and the patient recovered safely. A computed tomography revealed the rightward tracheal deviation and tortuous innominate artery contact with trachea. The patient didn't manifest any respiratory related symptoms during postoperative period, and she was discharged without any treatment.

Keywords: Fiberoptic bronchoscopy; Prone position; Tracheal compression; Vascular anomaly.

Fig. 1

Bronchoscopic findings of endotracheal tube. (A) Endotracheal tube fixed at 21 cm is near totally obstructed by soft tissue under prone position. (B) Tracheal lumen is maintained under prone position. The tube is fixed at 23 cm and the patient's neck is supported by a cotton roll. (C) Tracheal lumen is intact under supine position. The tube is fixed at 23 cm.

Fig. 2

Neck computed tomography shows rightward tracheal deviation (wide arrow) and tortuous innominate artery (narrow arrow) contact with trachea at right supraclavicular area beneath subcutaneous layer (A), and at thoracic inlet level (B).