Anesthesia management of a complicated post-COVID-19 tracheomalacia case with Y-shaped stent in an elderly morbidly obese patient: case report

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Abstract

Background
Members of anesthesia teams are involved in the management of COVID-19 infection cases at many stages particularly during acute airway interventions. Here, we describe a series of airway procedures to manage complex post-COVID-19 tracheomalacia in a high-risk patient.
Case presentation
A 67-year-old female with a medical history of diabetes mellitus, hypertension, and morbid obesity and recent COVID-19 infection requiring prolonged intubation presented to our hospital in severe respiratory distress. She was found to have long-segment tracheomalacia requiring multiple airway surgical procedures and stenting. During her hospital stay, she suffered multiple cardiac arrests due to respiratory failure and was not stabilized until airway tailored custom stent was inserted. She was later discharged with no significant long-term sequel.
Conclusions
It is important for the anesthesia staff, as part of the airway management plan team, to recognize the exact location and the anatomy of tracheomalacia. Certain anatomical deviations could affect our usual airway management pathways. Failure to do that can lead either to airway obstructions or detrimental hypoxia.

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