Airway and Ventilation Rescue During Tracheal Resection: A Case Report of Intraoperative Troubleshooting

Tracheal resection requires shared airway management when conventional ventilation fails. The present paper describes a 73-year-old man with chronic obstructive pulmonary disease (COPD), hypertension, and prior neck radiotherapy who underwent tracheal resection with primary anastomosis for chondrosarcoma. Initial intubation with a single-lumen endobronchial tube produced a major leak, requiring exchange to an endotracheal tube. Lung isolation with an EZ blocker® (Teleflex Life Sciences Ltd., Athlone, Ireland) was achieved but lost during thoracotomy in the lateral decubitus position with a chin stitch; an Arndt blocker also failed. Ventilation transitioned to high-frequency jet ventilation with intermittent apnea, cross-field ventilation, and intermittent endotracheal tube ventilation. A cuff rupture causing a leak was managed with cuff inflation, allowing successful extubation. The patient remained hemodynamically stable without complications and was discharged one week postoperatively at his functional baseline, with adequate oxygenation, good pain control, and full independence.