A Disabled Child with Incidental Postoperative Intensive Care Management due to Airway Stenosis after Extubation : A Case Report

<p>  A 6-year-old girl (height, 102 cm ; weight, 14 kg) with epilepsy and intellectual disability was scheduled to undergo a dental procedure for managing caries under ambulatory general anesthesia. The patient was induced with sevoflurane and intubated nasally with a 5.0 mm inner diameter cuffless tube. Some resistance was encountered during tube passage through the glottis. Anesthesia was maintained using intravenous propofol and remifentanil. Postoperatively, spontaneous respiration was confirmed, and the patient was extubated. However, 20 min post-extubation, the patient developed stridor in the recovery room. No skin symptoms were observed, and her oxygen saturation was 96-98% (room air). Fibroscopy revealed edema and worsening vocal cord movement ; therefore, the patient underwent oral reintubation under general anesthesia using a 3.5-mm cuffed tube. Following reintubation, the patient was admitted to the intensive care unit and managed with mechanical ventilation under sedation. Hereditary angioedema was rule out based on negative blood test results. Five days later, the edema and vocal cord movement improved, and the patient was successfully extubated. In this case, a tracheal tube with a 5.0-mm internal diameter was selected based on Cole’s formula and other factors. Since the patient was younger than the average 6-year-old, the relatively large-diameter tube may have led to the development of the edema. Notably, a standardized method for selecting tracheal tubes in children has not yet been established ; therefore, early detection and treatment of airway stenosis hold significant importance.</p>