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Case Reports in Anesthesiology
Volume 2012 (2012), Article ID 674918, 2 pages
http://dx.doi.org/10.1155/2012/674918
Case Report

Mounier-Kuhn Syndrome: Anesthetic Experience

1Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USA
2Department of Anesthesiology, Drexel University College of Medicine and Hahnemann University Hospital, New College Building, Room 7502, Philadelphia, PA 19102, USA

Received 28 November 2011; Accepted 2 February 2012

Academic Editors: R. S. Gomez, T. Ho, and D. Lee

Copyright © 2012 Deepu Sasikumaran Ushakumari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Mounier Kuhn syndrome, or congenital tracheobronchomegaly, is an under diagnosed clinical entity with peculiar anatomical and physiological features making anesthetic care challenging. A 58-year-old chronic smoker with history of recurrent pneumonia and bronchiectasis presented for septoplasty. Thoracic imaging revealed a dilated trachea and main bronchi, tracheal and bronchial diverticuli, and chronic bronchiectasis with mediastinal lymphadenopathy. An 8.5 cuffed endotracheal tube (ETT) proved too big for his glottic aperture. An 8.0 cuffed ETT with wet gauze packing yielding an adequate seal. Postoperative continuous positive airway pressure to prevent airway collapse followed awake extubation. Anesthetic concerns include grossly enlarged and weakened airways, inefficient cough mechanisms, presence of tracheal diverticuli, and post operative tracheal collapse. Anesthetic planning includes management of endotracheal cuff size. Small size yields air leak and ineffective ventilation. Large size may lead to mucosal damage. Tube dislodgement, copious secretions, chance of expiratory collapse due to the abnormally dilated and thin airways, and post operative monitoring all must be considered.