Anesthetic Management of a Patient with Saber-Sheath Trachea

Saber-sheath trachea is a deformation of the trachea characterized by a tracheal index of less than 0.67, commonly found in patients with chronic obstructive pulmonary disease (COPD). This condition can lead to symptoms such as shortness of breath, coughing, and recurrent respiratory infections, which may necessitate surgical intervention. We present the case of a 72-year-old male with a left upper pulmonary lobe tumor scheduled for thoracoscopic lobectomy. The patient exhibited severe emphysema and had a tracheal index of 0.28, indicating a significantly narrowed intrathoracic trachea. Preoperative assessments revealed stable vital signs and low risk for perioperative complications, allowing for standard noninvasive monitoring during the procedure. Anesthesia was induced while maintaining spontaneous breathing using inhalation anesthetics. A left-sided double-lumen endotracheal tube was successfully placed for lung isolation. Throughout the surgery, airway pressures remained below 20 cm H<sub>2</sub>O, and the patient tolerated ventilation well. Following the procedure, fiberoptic bronchoscopy confirmed the absence of airway complications. The patient experienced a smooth recovery, was discharged after 6 days, and reported feeling well at the 3-month follow-up. This case underscores the importance of careful anesthetic management in patients with saber-sheath trachea undergoing thoracic surgery.