Airway Control with a Laryngeal Mask Combined with High‑Flow Oxygen During Tracheal Resection and Reconstruction for Tumor‑Induced Critical Airway Obstruction: A Case Report

Abstract Background Primary tracheal tumors are rare but it can cause critical airway obstruction requiring urgent surgical resection and reconstruction. Airway management during tracheal surgery is highly challenging because anesthesia and surgery share the same airway, increasing the risk of loss of ventilation. This report describes a multimodal airway strategy—including supraglottic airway ventilation, distal tracheal intubation, and high‑flow oxygenation—used for emergency tracheal resection in a patient with > 95% tumor‑induced obstruction. Case Presentation: A 76‑year‑old woman presented with hemoptysis and progressive dyspnea. Imaging and bronchoscopy revealed a friable intraluminal tracheal tumor causing near‑complete obstruction at the cervical trachea. Because intubation through the stenosis was unsafe, anesthesia was induced using high‑flow nasal oxygen and ventilation via a ProSeal laryngeal mask airway (LMA). After tracheal exposure, distal tracheal intubation provided controlled ventilation during tumor resection. During anastomosis, apnea with high‑flow oxygen (70 L/min) through the proximal endotracheal tube provided an unobstructed surgical field while maintaining oxygenation. The patient was extubated in the operating room and discharged on postoperative day five. Conclusions Laryngeal mask ventilation combined with staged distal intubation and high‑flow apneic oxygenation offers an effective and safe airway strategy for selected patients with critical tracheal obstruction due to tumor. This approach may reduce airway trauma and maintain surgical exposure without compromising oxygenation.