Unanticipated Difficult Intubation in a Patient with an Asymptomatic Epiglottic Cyst / 대한마취과학회지

ABSTRACT

Although an epiglottic cyst is often asymptomatic and harmless to the patient, discovery of a large epiglottic cyst after induction of anesthesia is a potentially life-threatening problem for the patient and provides a challenge for the anesthesiologist in airway management. We experienced a case of unanticipated difficult mask ventilation and intubation as a result of an asymptomatic epiglottic cyst. A 37-year-old woman presented for elective removal of a brain tumor. She had normal mouth opening and neck extension; no masses or distortions of the tongue or neck were observed. She was premedicated with 0.2 mg glycopyrrolate intramuscularly. Anesthesia and paralysis were induced with 250 mg thiopental, fentanyl 100ng and pipecuronium 6 mg. It was noted that ventilation of the lungs via mask was difficult. Despite insertion of an oropharyngeal airway, ventilation proved to be more difficult. Intubation was attempted. Direct laryngoscopy revealed a 2 cm cyst arising from the epiglottis. The cyst completely obscured the view of the epiglottis and larynx, preventing intubation despite multiple attempts by three anesthesiologists. We consulted an otolaryngologist and awakened the patient. During further questioning in the post anesthesia care unit she admitted to a several-years of dysphagia. Next day, she was admitted to the operation room for removal of an epiglottic cyst. She was intubated using fiberoptic bronchoscope guided awake intubation, and the remainder of anesthetia and the operation proceeded uneventfully. The pathology report confirmed the finding of a 2.5 X 1.5 X 1.5 cm epidermal cyst.