Near total airway obstruction due to tracheal granulations: an anesthesiologist's nightmare

A 17 year old boy, post tracheoplasty, presented to emergency in respiratory distress with presence of stridor at rest. Flexible bronchoscopy revealed granulations at tracheal graft site causing airway stenosis. The presence of graft perculded use of invasive surgical approaches due to risk of damage.The anesthetic management options in this case carried inherent risks of causing total airway obstruction and impairing surgical access. We decided to perform the electrocauterization of tracheal granulations using subglottic jet ventilation while placing the catheter above the stenotic trachea