Walking a tightrope – A multitude of airway challenges in a mediastinal mass excision

Providing a satisfactory lung isolation during the video-assisted thoracoscopic surgery in infants can be challenging due to the limited options for one lung ventilation. Additional anatomic pathologies/derangements add to the complexity in managing the airway in these tiny infants. We discuss a case of a 10-month infant scheduled for video-assisted excision of a recurrent bronchogenic cyst that was in proximity to recurrent laryngeal nerves, compressing the trachea and bronchus. The associated severe tracheo-bronchomalacia and the risk of an inadvertent recurrent laryngeal nerve injury demanded a need to exercise caution and necessitated a personalised approach to aid surgery. This article aims to outline the several airway challenges encountered intraoperatively in this infant and thereby contribute to the literature on the management of such cases. While it is imperative to tailor the management strategies to individual case, we endeavour to navigate the intricate complexities and ensure optimal patient outcomes.