Videolaryngoscopic Retrieval of a Chronically Retained Glottic Foreign Body Under Ketamine Sedation With Preserved Spontaneous Ventilation: A Case Report

Long-retained laryngeal foreign bodies in adults are rare and easily mistaken for chronic laryngeal disease.They pose a specific airway dilemma: the obstruction lies exactly where the anesthesiologist must work, and tracheal intubation may push the object further down.We describe a 63-year-old man with type 2 diabetes and hypertension who had a foreign body lodged across the glottis after a food-bolus impaction.His symptoms had begun more than one year earlier, but the diagnosis was made only a few months before treatment.He presented three times to the emergency department with dysphonia, wheeze, and progressive dyspnea, with unremarkable neck CT and chest radiography.The object was suspected on otolaryngologic examination and confirmed once corticosteroids had reduced severe laryngeal edema.An outpatient attempt at removal with a flexible bronchoscope failed.Intubation was judged unsafe because the tracheal tube could have displaced the object into the trachea.The anesthesiologist removed it under deep sedation (ketamine 50 mg, midazolam 3 mg, atropine 0.5 mg, topical lidocaine) with spontaneous ventilation and nasal oxygen at 4 L/min, using a GlideScope videolaryngoscope (Verathon, WA, USA) and curved forceps.The otolaryngologist stood by in the operating room to perform a tracheostomy if needed.The object, a thin translucent lamina of about 30 × 25 mm, came out intact in about 10 minutes, with stable vital signs (SpO 2 99%).The patient was discharged the next day.When intubation is itself the hazard, a tubeless shared airway under ketamine-based sedation, with a pre-agreed surgical rescue plan, can be the safest option.