# Unexpected Airway Collapse: A Rare Case of Spontaneous Postoperative Tracheobronchomalacia in the Absence of Identifiable Risk Factors

## TL;DR

A patient developed unexpected airway collapse after surgery without known risk factors, requiring specialized ventilation.

## Contribution

This case highlights a rare instance of postoperative tracheobronchomalacia without identifiable risk factors.

## Key findings

- Tracheobronchomalacia occurred immediately after a robotic hysterectomy.
- Dynamic anterior-posterior collapse of over 50% was observed during bronchoscopy.
- A laryngeal mask airway was effective for ventilation when endotracheal intubation failed.

## Abstract

We report the case of a 53-year-old female who developed tracheobronchomalacia immediately following an uncomplicated robotic hysterectomy with bilateral salpingo-oophorectomy to treat postmenopausal bleeding. Induction of anesthesia was notable for moderately difficult intubation, managed with applied cricothyroid pressure and a small 6.5 endotracheal tube placement via GlideScope. The surgical course was uneventful. The patient remained intubated in the post-anesthesia care unit but was not providing end-tidal volumes. Attempts to replace the endotracheal tube with a larger tube were unsuccessful and the patient was temporarily unable to ventilate. Rapid troubleshooting discovered that a laryngeal mask airway (LMA) could sufficiently ventilate the patient. An otolaryngologist was able to perform direct bronchoscopy, which revealed more than 50% dynamic anterior-posterior collapse of the trachea and bronchi. The patient was subsequently awakened from anesthesia and monitored in the intensive care unit, ventilating with an LMA. After a couple of hours, it was determined that the patient’s airway was protected, and the LMA was removed.