Neonates with laryngeal webs pose unique challenges to the anesthesiologist. We present a 2-day-old neonate with aphonia and stridor who underwent microdirect laryngoscopy. Intraoperatively, a Cohen type 4 laryngeal web was diagnosed not immediately amenable to resection. Therefore, the decision was made for endotracheal intubation and subsequent tracheostomy. After endotracheal intubation, there was acute respiratory compromise and oxygen desaturation that improved moderately after urgent tracheostomy. A chest radiograph revealed a large pneumothorax. Our experience suggests that in the presence of high-grade laryngeal webs, the possibility of intraoperative development of pneumothorax should be considered if respiratory difficulties are encountered.
From the *Division of Pediatric Anesthesiology, Department of Anesthesiology, Omaha Children’s Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
†ENT Specialists, Omaha, Nebraska.
Accepted for publication February 12, 2018.
The authors declare no conflicts of interest.
Address correspondence to Michelle M. LeRiger, MD, Division of Pediatric Anesthesiology, Department of Anesthesiology, Omaha Children’s Hospital and Medical Center, 8200 Dodge St, Omaha, NE 68114. Address e-mail to email@example.com.