Abstract
Tracheal diverticulum (TD) is a paratracheal air cyst communicating with the trachea
through an ostium. Administering general anesthesia with positive pressure ventilation
in TD carries the risk of diverticulum rupture, leading to complications. To mitigate
these risks, it is crucial to seal/bypass the ostium using an endotracheal tube (ETT)
cuff, which may require deeper placement. Deeper placement can increase the likelihood
of unintended endobronchial intubation, particularly in patients with a short trachea.
We describe here the fiberoptic bronchoscopy-assisted technique of intubation, where
the TD ostium was successfully identified and sealed using a single-lumen ETT cuff
in a 60-year-old man who underwent C4-T1 intramedullary tumor excision with an incidental
TD. Anesthesiologists should have a detailed knowledge of the size, location of the
ostium, the extent of TD, and its compressive effects on the trachea, which enables
them to select an appropriate intubation technique using a correct size ETT to seal/bypass
the orifice while preventing complications.
Keywords
diverticular ostium - general anesthesia - positive pressure ventilation - tracheal
diverticulum
