A difficult intubation: prolapse of the epiglottis into the trachea in an infant
Dehne, M.G.; Knothe, C.; Hempelmann, G.
Der Anaesthesist 42(6): 386-387
1993
ISSN/ISBN: 0003-2417 PMID: 8342749 Document Number: 415511
Luxation of the epiglottic cartilage is a very uncommon complication of endotracheal intubation in paediatric anaesthesia. We report on a case of prolapse of the epiglottic cartilage into the trachea in a 4-month-old child who had been anaesthetized for palliative banding of the pulmonary artery and correction of a coarctation of the aorta. Further malformations included a single ventricle combined with an ASD II and VSD. The first intubation (ID 3.5 mm) via the nasopharyngeal route seemed not to involve any problems; breathing pressure, however, increased to 25 cm H2O. Direct laryngoscopy after extubation of the smaller tube and insertion of another one (ID 4.0 mm) demonstrated a completely blocked trachea. The epiglottidean cartilage had prolapsed into the tracheal lumen and excluded any possibility of ventilating the patient. After seizing the epiglottic cartilage with a Magill forceps it was possible to pull the cartilage out of the trachea and to intubate again with the 4.0 mm tube. There were no complications in the postoperative period.