Severe tracheal compression caused by a giant brachiocephalic trunk aneurysm with intraoperative tracheal perforations: a combined anatomical and physiological difficult airway case report

This report describes the anesthetic management of a patient with a giant brachiocephalic trunk aneurysm (maximum diameter approximately 7.7 cm) causing severe tracheal compression, resulting in a combined anatomical (central airway stenosis, with a CT axial minimal transverse diameter of only 3.99 mm) and physiological (compromised respiratory function) difficult airway. The patient presented with dyspnea and pulmonary infection preoperatively. After multidisciplinary discussion, rapid sequence induction combined with videolaryngoscopy-assisted intubation was performed under wet-primed cardiopulmonary bypass (CPB) standby protection. Two episodes of secretion-induced airway obstruction occurred intraoperatively, and the endotracheal tube was exchanged under CPB support. Tracheal perforation was identified after weaning from CPB and was repaired during the same procedure. The patient recovered well and was discharged uneventfully.