Airway Management of Granuloma Post Intubation: 2 Cases Report

Case Series

Austin J Anesthesia and Analgesia. 2023; 11(1): 1113.

Airway Management of Granuloma Post Intubation: 2 Cases Report

Walid Atmani*; Ayoub Boubekri; Abdelhamid Jaafari; Abdelouahed Baite; Mustapha Bensghir

Pole Anesthésie-Réanimation Hôpital Militaire d’Instruction Mohamed V Rabat, Morocco

*Corresponding author: Walid Atmani Pole Anesthésie-Réanimation Hôpital Militaire d’Instruction Mohamed V Rabat, Morocco. Email: atmani.walid@gmail.com

Received: May 08, 2023 Accepted: June 03, 2023 Published: June 10, 2023

Abstract

Tracheal intubation is a common procedure during General Anesthesia. It consists in introducing a probe into the trachea. This simple act remains not without risks. Various incidents and complications have been described due to this procedure. Among these is granulomas. Different factors and mechanisms are responsible for these complications. The prolongation of the intubation especially in intensive care remains the main causative factor of the development of granulomas, on the other hand this complication remains infrequent in anesthesia. The main clinical signs are dyspnea or a change in voice. Surgery is often required. Through two clinical cases of granulomas developed after surgery, the authors discuss the mechanisms and requirements for anesthetic management of this type of complication.

Keywords: Anesthesia; Tracheal intubation; Dyspnea; Granuloma; Surgery

Introduction

Tracheal intubation is an undissociated act of general anesthesia, and consists of the introduction of a probe in the trachea to ensure respiration and ventilation in a patient freed up in apnea. The frequency of laryngeal lesions after translaryngeal intubation differs in published studies. The pathophysiology of these lesions includes mucosal ischemia and other unclear factors. Post-extubation dyspnea uncommonly results from laryngeal edema; edema may result from lesions of laryngeal mucosa [1].

Moreover, this gesture sometimes does not remain trivial, and burdened with complications that can be immediate as dyspnea, dysphagia or late-onset type of granuloma, [2] making any other intubation difficult and the management of the upper airway impossible because of laryngeal obstruction Indeed, granulomas, trachomalacia, oeso-tracheal fistula... are frequent complications, seen especially in case of prolonged intubation [3,4] in patients in intensive care but rarely in case of general anesthesia for a gesture more or less fast.

We describe the clinical observation of two post-intubation granuloma cases in two patients with upper airway management measures.

Observations

Patient 1:

Patient and observation: A 34-year-old female patient was addmitted to the ear, nose andt hroat clinic with shortness of breath and dysphonia lasting for 2 months, her personal history revealed total thyrodectomy 2 months ago. No dyspnea or history of alcoholism, smoking associated; no trismus or other symptom noted.

The last surgery had lasted 2 hours, intubation was difficult 2 temptations with guide support and had performed by endotracheal army tube n°7mm, intubation and anesthesia had been completed without complications

Diagnosis: Echo-endoscopic exploration showed two rounded formations arising on both sides of the vocal cords with obstruction of 2/3 of tracheal light Figure 1 surgical indication was posed and consist on microlaryngeal surgery under general anesthesia

Citation: Atmani W, Boubekri A, Jaafari A, Baite A, Bensghir M. Airway Management of Granuloma Post Intubation: 2 Cases Report. Austin J Anesthesia and Analgesia. 2023; 11(1): 1113.