Shared Airway for Tracheal Resection and Anastomosis in a Patient with Severe Subglottic Stenosis after Intra-cardiac Repair for Tetralogy of Fallot

Subglottic stenosis is a condition causing narrowing of the trachea, which can occur rarely secondary to trauma, infection, tumors, inflammatory, and iatrogenic causes. In our case, the child developed subglottic stenosis post-cardiac surgery after being mechanically ventilated in the postoperative period. The causes for subglottic stenosis may be some trauma in the presence of coagulation abnormalities in cyanotic heart diseases such as TOF, the ischemia to the subglottic tissue by reduced perfusion during cardiopulmonary bypass, and/or the trauma caused by crying and fighting of the child while being with the endotracheal tube. Anesthetic management of the surgery is challenging for the anesthesiologist due to the shared airway by the surgeon and the anesthesiologist. The inability to effectively ventilate the patient after induction of general anesthesia will result in catastrophic complications. Subglottic stenosis requires careful planning and execution along with proper communication between the team.