Wegeners Granulomatosis and Subglottic Stenosis - A Case Report

Subglottic stenosis is a rare but life threatening condition and is caused by congenital anomalies, tracheal tumors, trauma, autoimmune disorders like Wegener?s granulomatosis, amyloidosis, sarcoidosis etc. Wegener's granulomatosis is a multisystemic disease characterized by foci of necrotizing vasculitis and granuloma formation. Subglottic stenosis is seen in 10-20 % of the cases either as a presenting feature or a late-stage manifestation of the disease. We report a case of 36 year old lady with Wegener?s granulomatosis scheduled for bilateral FESS and myringotomy with grommet insertion. Systemic examination was normal except for the presence of bilateral hearing loss. The patient had no symptoms indicating a subglottic stenosis. Following induction, mask ventilation was confirmed and succinylcholine was administered. Intubation was attempted but was unsuccessful. Patient was ventilated by mask untill the effect of succinylcholine weaned off. Awake fibre optic intubation was tried and a severe subglottic stenosis was found. The surgery was postponed till further evaluation. The purpose of this report is to discuss and explore a few management strategies when providing general anaesthesia to a patient with subglottic stenosis.