Optimizing the Endotracheal Tube Cuff Position in Adult Patients with Tracheal Diverticulum Undergoing General Anesthesia: A Case Report

Tracheal diverticulum (TD) is a paratracheal air cyst communicating with the trachea through an ostium. Administering general anesthesia with positive pressure ventilation in TD carries the risk of diverticulum rupture, leading to complications. To mitigate these risks, it is crucial to seal/bypass the ostium using an endotracheal tube (ETT) cuff, which may require deeper placement. Deeper placement can increase the likelihood of unintended endobronchial intubation, particularly in patients with a short trachea. We describe here the fiberoptic bronchoscopy-assisted technique of intubation, where the TD ostium was successfully identified and sealed using a single-lumen ETT cuff in a 60-year-old man who underwent C4-T1 intramedullary tumor excision with an incidental TD. Anesthesiologists should have a detailed knowledge of the size, location of the ostium, the extent of TD, and its compressive effects on the trachea, which enables them to select an appropriate intubation technique using a correct size ETT to seal/bypass the orifice while preventing complications.