Anesthetic Management of a Tracheal Deformity in an Elderly Patient With Chronic Obstructive Pulmonary Disease: A Case Report

Saber sheath trachea is a tracheal deformity characterized by marked transverse narrowing relative to the anteroposterior diameter and is frequently associated with chronic obstructive pulmonary disease (COPD). Although saber sheath trachea has been discussed as a potentially challenging airway in anesthetic practice, perioperative airway complications have been reported mainly in individual case reports, and their true incidence, severity, and clinical implications remain uncertain. We report the anesthetic management of an elderly patient with COPD and saber sheath trachea undergoing laparoscopic surgery under general anesthesia. Preoperative chest computed tomography demonstrated a marked transverse narrowing of the intrathoracic trachea, and quantitative assessment of tracheal dimensions was performed. Based on these findings, the endotracheal tube was selected with a careful consideration of its external diameter. Airway management and extubation strategies were planned in advance, with particular attention to perioperative phases associated with increased airway vulnerability. General anesthesia was induced and maintained uneventfully, and intraoperative ventilation remained stable without cuff leakage or ventilatory instability. Extubation was performed cautiously with preparation for potential airway obstruction. No perioperative airway complications, including negative pressure pulmonary edema, were observed, and the postoperative course was uncomplicated. This case illustrates that saber sheath trachea should be interpreted as a morphological condition rather than an automatic high-risk airway label. In patients with predominant transverse narrowing, CT-based assessment of tracheal dimensions may help guide airway planning, particularly with respect to endotracheal tube selection and extubation strategy.