Laringealni hondrosarkom: uspješna primjena videolaringoskopa u zbrinjavanju očekivanog otežanog dišnog puta

Laryngeal chondrosarcoma is a rare mesenchymal tumor, most frequently affecting cricoid cartilage. The objective of this report is to present successful video laryngoscope usage in a patient with anticipated difficult airway who refused awake fiberoptic endotracheal intubation (AFOI). A 59-year-old male patient was admitted in our hospital due to difficulty breathing and swallowing. On clinical examination performed by ENT surgeon, preoperative endoscopic airway examination (PEAE) could not be performed properly due to the patient’s uncooperativeness. Computed tomography revealed a spherical tumor that obstructed the subglottic area almost entirely. Due to the narrowed airway, the first choice for the anticipated difficult airway management was AFOI, which the patient refused. Consequently, we decided to perform endotracheal intubation with indirect laryngoscope using a C-MAC video laryngoscope (Karl Storz, Tuttlingen, Germany). Reinforced endotracheal tube (6.0 mm internal diameter) was placed gently between the tumor mass and the posterior wall of the trachea in the first attempt. Confirmation of endotracheal intubation was done by capnography. In a patient with subglottic area chondrosarcoma refusing PEAE and AFOI, video laryngoscope is a particularly helpful device for difficult airway management when difficult airway is anticipated.Laringealni hondrosarkom je rijedak mezenhimni tumor koji najčešće zahvaća krikoidnu hrskavicu. Svrha ovoga rada je prikazati uspješnu primjenu videolaringoskopa u bolesnika s očekivanim otežanim dišnim putem koji odbija fiberoptičku endotrahealnu intubaciju na budno. Pedesetdevetogodišnji muškarac je primljen u našu bolnicu zbog otežanog disanja i gutanja. Zbog nesuradljivosti bolesnika otorinolaringolog nije uspio učiniti odgovarajući prijeoperacijski endoskopski pregled dišnog puta. Učinjena kompjutorska tomografija je pokazala sferičan tumor koji je skoro u potpunosti opstruirao subglotično područje. Zbog uskog dišnog puta prvi izbor za postupak s očekivanim otežanim dišnim putom je bila fiberoptička endotrahealna intubacija na budno koju je bolesnik odbio. Posljedično, odlučili smo izvesti endotrahealnu intubaciju indirektnom laringoskopijom pomoću videolaringoskopa C-MAC (Karl Storz, Tuttlingen, Njemačka). U prvom pokušaju je armirani endotrahealni tubus (unutarnji promjer 6,0 mm) nježno postavljen između tumorske mase i stražnjega zida traheje. Kapnografom je potvrđena endotrahealna intubacija. Zaključno, videolaringoskop je korisno pomagalo u održavanju otežanog dišnog puta u bolesnika s hondrosarkomom subglotičnog područja koji odbija fiberoptičku endotrahealnu intubaciju na budno, a u kojega se očekuje otežani dišni put