Case Report:
A 13-month-old patient (8.9 kg) post-esophagoscopy and button battery
removal presented for surgical repair of 30% complete tracheal erosion
from cervical 6-thoracic 1. Past medical history included recent upper
respiratory tract infection, resolving viral myocarditis, sick euthyroid
syndrome, and salt wasting syndrome. Pre-operatively, the critical
airway was at risk for life-threatening tracheal separation, bleeding
(if aorto-esophageal fistula formed), and mediastinitis. Physical
examination showed stable vital signs with diminished air entry to left
lung. Chest x-ray demonstrated right upper lobe atelectasis and left
lung base airspace opacity.
The patient arrived to the operating room already intubated in stable
condition and was premedicated with midazolam and fentanyl. General
anesthesia was induced with cis-atracurium, fentanyl, and propofol.
Under direct vision, the otolaryngologist extubated the trachea.
Albuterol and epinephrine were administered for bronchodilation. After
encountering ventilation difficulty from bloody secretions, a 3.5 cuff
tracheostomy tube was successfully placed.
One week later, the patient underwent direct laryngoscopy/bronchoscopy
and TEF repair. General anesthesia was induced with rocuronium,
fentanyl, and propofol. Total intravenous anesthesia was maintained with
propofol infusion and fentanyl boluses. Upon conclusion of surgery, the
patient was awakened with trachea extubated uneventfully. The patient
recovered without respiratory or cardiovascular complications.