Failed fiberoptic intubation and surgical tracheostomy in a case of Down’s Syndrome with goiter

Difficult airway management is a great challenge to the anaesthesiologist. Fiberoptic intubation is a well-established technique in anticipated difficult airway but rarely does it fail due to some abnormality, where elective tracheostomy is an option to secure the airway. We report a difficult scenario of failure of most commonly recommended techniques to secure the anticipated difficult airway in an adult patient having Down’s syndrome with mental retardation and goiter causing tracheal compression. Awake fiberoptic bronchoscopy assisted intubation under local anaesthesia was planned. Negotiation of the scope up to the larynx was not possible due to anomalous laryngeal structure, mucosal polyps and multiple angulations of the airway. Two attempts of blind nasal intubation also failed. So the decision of surgical tracheostomy under local anaesthesia was taken. Due to the presence of thyroid swelling, distorted tracheal anatomy and patient’s lack of cooperation tracheostomy was unsuccessful.

DOI: http://dx.doi.org/10.4038/slja.v21i2.5448