Tracheocutaneous Fistula Anesthetic Obstacles

Document Type

Conference Proceeding

Publication Date



A 38 year female with a history of neck dissection for nasopharyngeal carcinoma and mandible resection and reconstruction with fibula flap tracheostomy for osteoradionecrosis presented for closure of tracheal fistula with skin graft to neck. Patient was Mallampati IV and had limited neck ROM, minimal mouth opening, and no tongue protrusion. Due to the concerning airway, the procedure was done under local anesthetic and light sedation. Patient was induced with ketamine and dexmedetomidine infusion with midazolam bolus. Oxygen was delivered through nasal cannula with intermittent pauses in delivery for electrocautery usage on the neck. Will discuss this patient’s anesthetic challenges.


American Society of Anesthesiologists Annual Meeting, October 12-16, 2023, San Francisco, CA