[Airway obstruction after general anesthesia in a patient with the first and second branchial arch syndrome].

A 20-year-old female with the first and second branchial arch syndrome underwent plastic surgery. Due to her mandibular hypoplasia and trismus, tracheal intubation was difficult even with a broncho-fiberscope. Fentanyl 100 micrograms was used for nasal intubation. Anesthesia was maintained with nitrous oxide (4 l.min-1), oxygen (2 l.min-1) and sevoflurane (0.5-3%). There were no troubles during surgery. The trachea was extubated after recovery of consciousness and spontaneous respiration. Five minutes after extubation, airway was obstructed suddenly after massive nasal bleeding. Sudden massive bleeding might have caused airway obstruction. Emergency insertion of an 18 G needle followed by Mini-trach II into the trachea through the cryothyroidal ligament improved her respiratory condition. The case suggests that preparing the instrument for the emergency cryothyroidal ligament puncture (for instance Mini-trach II) is useful for a patient with a risk of bleeding in the airway and with difficult intubation.