# Airway Management During Laparoscopic Surgery in a Patient With Saber Sheath Trachea: A Case Report

## TL;DR

This case report describes successful airway management during laparoscopic surgery in a patient with a rare tracheal condition called saber-sheath trachea.

## Contribution

The paper presents a novel airway management approach using a second-generation supraglottic device in a challenging clinical scenario.

## Key findings

- The use of a ProSeal laryngeal mask airway avoided complications during surgery and recovery.
- No tracheal collapse or surgical difficulties occurred during mechanical ventilation.
- Second-generation supraglottic devices may be a viable alternative for similar cases.

## Abstract

Saber-sheath trachea is a U-shaped diffuse narrowing of the thoracic trachea, specifically observed in patients with chronic obstructive pulmonary disease. The airway management of patients with saber-sheath trachea can be challenging because it possesses characteristics both of tracheal stenosis and tracheomalacia. A 78-year-old man was diagnosed with gastric cancer and underwent robot-assisted laparoscopic total gastrectomy with jejunal interposition reconstruction. We provided general anesthesia combined with thoracic epidural anesthesia for this case. For intraoperative airway management, we chose the ProSeal laryngeal mask airway (PLMA) (Senko Medical Instrument Mfg. Co., Ltd., Tokyo, Japan) to avoid potential problems associated with tracheal intubation. We did not experience any surgical difficulties during intraoperative mechanical ventilation or tracheal collapse during the course of the recovery of spontaneous ventilation and emergence from anesthesia. We believe that the use of second-generation supraglottic airway devices with esophageal drainage tubes may be considered as an alternative option for airway management in similar cases involving saber-sheath trachea.