# Tracheal Deviation and Airway Management: Clinical Considerations From a Cadaver

## TL;DR

This paper highlights the challenges of airway management in patients with severe tracheal deviation due to unusual aortic anatomy, using a cadaver case to emphasize the need for detailed anatomical knowledge.

## Contribution

The paper presents a unique cadaver case with meandering multiple aortas causing tracheal deviation and outlines clinical risks for airway management.

## Key findings

- Severe tracheal deviation was associated with difficulty in tracheal intubation and ventilation.
- The tortuous brachiocephalic artery posed a risk of hemorrhage during emergency tracheostomy.
- Anatomical knowledge is critical for safe airway management in such cases.

## Abstract

Severe tracheal deviation detected on preoperative chest radiographs is one of the risk factors for difficult tracheal intubation and difficulty in ventilation using an endotracheal tube after tracheal intubation when managing the airway through tracheal intubation under general anesthesia. In this report, we describe the cadaver of an 81-year-old woman with marked tracheal deviation due to meandering multiple aortas. This report details the importance of anatomical knowledge in developing a detailed airway management plan. The deviated trachea was removed from the cadaver and the tracheal tube was inserted at the glottis to the proximal end of the glottal marker. The tube tip was in contact with the tracheal wall, suggesting ventilation difficulty during intubation. The tortuous brachiocephalic artery passed in front of the trachea, which posed a risk of massive aortic hemorrhage and postoperative trachea-brachiocephalic artery fistula during percutaneous tracheostomy for emergency airway management. The anatomical location of the trachea and carotid artery must be confirmed before surgery/anesthesia to ensure safe airway management.