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.