A Case of Differential Lung Ventilation Using a Double-Lumen Endotracheal Tube via Tracheostomy in a Patient With Acquired Laryngeal Web Undergoing Lobectomy

Acquired laryngeal web is associated with difficult airway management during anesthesia induction or extubation. We experienced a case of lung resection under general anesthesia in a patient who was preoperatively diagnosed with a laryngeal web. The patient was a 78-year-old female (height: 153 cm, weight: 59 kg, BMI: 25.1 kg/m²) scheduled for right lung lobe resection under general anesthesia. She had been diagnosed with a laryngeal web fourteen years earlier and had undergone surgery twice to improve the airway stricture. Since preoperative laryngoscopic assessment indicated the potential for laryngeal edema due to stimulation from tracheal intubation and extubation, we decided to perform a tracheostomy under regional anesthesia before the induction of general anesthesia. After securing a reliable airway, we induced general anesthesia and replaced the tracheostomy tube with a left-sided double-lumen tube via the tracheostomy. We were able to successfully conduct stable one-lung ventilation without any intraoperative complications. Her postoperative course was relatively stable, and the tracheal tube was removed on postoperative day two. She has subsequently not experienced any stricture-related symptoms. It is important to reliably secure the airway via a surgical approach instead of tracheal intubation in adult patients with an acquired laryngeal web, as laryngeal stimulation can easily cause edema. We considered a surgical airway to be essential in this patient with an acquired laryngeal web undergoing surgery under general anesthesia.