Anaesthetic challenges in recurrent respiratory papillomatosis with unyielding lesion.

Recurrent respiratory papillomatosis (RRP) is one of the most common laryngeal lesions in children. A 14-year-old female presented with complaints of a change in voice and noisy breathing. She underwent excision of laryngeal papillomatosis thrice before. Fibreoptic laryngoscopy revealed that the lesion was occluding the entire glottic chink except for a small opening through which she was breathing. As there was a risk of seeding of the distal airway following tracheostomy, the initial plan of tracheostomy was deferred. Anaesthesia was induced with sevoflurane. C-MAC™ laryngoscopy revealed that the entire glottic chink was occupied with the papillomatous lesion, and no opening was visualised. The lesion could not be negotiated with a 4 mm endotracheal tube and started bleeding. Immediately, surgeon was asked to perform a tracheostomy. With each recurring incidence of RRP, the probability of the papilloma's non-yielding nature may increase, making the negotiation of the lesion impossible. [ABSTRACT FROM AUTHOR]