Emergency Airway Management of a Relapsing Polychondritis Patient with Tracheal Stent Migration: a case report

Background Relapsing polychondritis is a rare autoimmune disorder that can cause progressive inflammation and destruction of cartilaginous structures. Relapsing polychondritis often develops into severe tracheobronchial stenosis with malacia. Airway management of patients with relapsing polychondritis is challenging due to airway compromise. Case presentation A 71-year-old male with Relapsing polychondritis and a history of tracheobronchial stent implantation presented to the emergency intensive care unit after a traumatic fall, manifesting respiratory distress and tracheal intubation was requested. A cephalad migrated stent makes it difficult to align endotracheal tube with stent lumen. Intubation under video laryngoscopy was performed with an unexpected gastroesophageal regurgitation making the situation more complicated. A 7.0-size endotracheal tube was rapidly inserted and the cuff inflated at level of vocal cords(due to the difficult to further insertion of the endotracheal tube) to prevent aspiration and after fully suction of the gastric contents, the endotracheal tube was adjusted under flexible bronchoscopy guidance into the stent lumen. Conclusions Night-shift emergency intubation, an unexpected gastroesophageal regurgitation, airway stent migration and respiratory compromise make airway management full of challenges in this patient. Anesthesiologist encountering this rare disease must be aware of the life-threatening complications that may occur during airway management.