Introduction. Saber-sheath trachea is a rare malformation of the trachea
marked with coronal narrowing with concomitant widening of sagittal
diameter, with a sagittal-to-coronal diameter ratio exceeding 2:1. As
tracheal rings are stiff and do not collapse around the tube, the intubation
is difficult. Case Report. A 53-year-old female was referred to our hospital
due to failed intubation at the local hospital during a planned surgery of
skin melanoma. The patient was scheduled for surgery in our hospital, her
case was presented to a panel of anesthesiologists and she was prepared for
surgery. The intubation failed again, even though a video-assisted
laryngoscope and endotracheal tube with 5 mm internal diameter was used. The
anesthesiologist noticed that the endotracheal tube entered the trachea only
2 cm due to strong resistance, so further intubation was not an option in
order to avoid damaging the trachea. The surgery was performed in local
anesthesia with analgosedation. Later on, computed tomography was done,
because of suspected pathological process compressing trachea, but the
radiologist described the anomaly as saber-sheath trachea. One year later,
the patient presented with axillary lymph node metastases and needed another
surgery. This time the anesthesiologist knew about the trachea malformation,
anticipated difficult intubation and used i-gelTM for airway management.
Conclusion. Despite the fact that numerous methods have been developed for
the purpose of identifying patients at risk of difficult intubation, there
are many unexpected airway pathologies that can lead to failed intubation.
Adequate preoperative assessment, knowledge of Guidelines for Difficult
Intubation Management, availability of supraglottic airway devices, and
cooperation between the surgeon and anesthesiologist, are crucial to
successful patient management.