Case Report Anesthetic Management for Laser Excision of Ball-Valving Laryngeal Masses Benjamin B. Bruins, 1 Natasha Mirza, 2 Ernest Gomez, 3 and Joshua H. Atkins 4 1 Department of Anesthesiology & Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA 2 Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, Te University of Pennsylvania, Philadelphia, PA 19104, USA 3 Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA 4 Department of Anesthesiology & Critical Care, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, Te University of Pennsylvania, PA 19104, USA Correspondence should be addressed to Joshua H. Atkins; atkinsj@uphs.upenn.edu Received 18 February 2015; Accepted 17 April 2015 Academic Editor: Pavel Michalek Copyright © 2015 Benjamin B. Bruins et al. Tis 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. A 47-year-old obese woman with GERD and COPD presents for CO 2 -laser excision of bilateral vocal fold masses. She had a history of progressive hoarseness and difculty in breathing. Nasopharyngeal laryngoscopy revealed large, mobile, bilateral vocal cord polyps that demonstrated dynamic occlusion of the glottis. We describe the airway and anesthetic management of this patient with a topicalized C-MAC video laryngoscopic intubation using a 4.5mm Xomed Laser Shield II endotracheal tube. We examine the challenges of anesthetic management unique to the combined circumstances of a ball-valve lesion and the need for a narrow-bore laser compatible endotracheal tube. 1. Introduction Airway management of the patient with a glottic lesion producing dynamic total airway occlusion (ball-valve efect) requires a specialized management plan [1]. Induction of general anesthesia, loss of hypopharyngeal tone, abolition of spontaneous ventilation, and initiation of positive pressure ventilation can result in the inability to ventilate and/or intubate. For these reasons, airway management in patients with large or periglottic airway masses is ofen accomplished with awake or minimally sedated fberoptic bronchoscopic endotracheal tube placement [2, 3]. Te added requirement for laser surgery at the glottis around a narrow-bore (<6 mm) endotracheal tube limits this approach. We describe success- ful topicalized-sedated intubation with Storz C-MAC (Karl Storz, Tuttlingen, Germany) videolaryngoscopy and charac- terize technical limitations associated with blind techniques and laser tubes. Te patient gave written consent for publication of the details of the case. 2. Case Description A 47-year-old, obese (BMI 33) woman with GERD, COPD, and 60-pack year smoking history presented to the oper- ative theater for CO 2 -laser excision of bilateral vocal fold polyps. Home medications included a proton pump inhibitor and inhaled beta-2 agonist. Preoperative nasopharyngeal laryngoscopy demonstrated a lef highly mobile polyp that herniated from a supraglottic position during expiration to a subglottic position during inspiration and a smaller right polyp. Airway occlusion was estimated at 70–80% by the surgical team as depicted in video 1 in Supplementary Mate- rial available online at http://dx.doi.org/10.1155/2015/875053. Te patient declined tracheostomy and was scheduled for Hindawi Publishing Corporation Case Reports in Anesthesiology Volume 2015, Article ID 875053, 3 pages http://dx.doi.org/10.1155/2015/875053