J Korean Dent Soc Anesthesiol.  2010 Dec;10(2):190-196. 10.17245/jkdsa.2010.10.2.190.

Airway Management in the Patients of Expected Difficult Intubation: A Case Report

• O SR
• Lee JH

• KMID: 2345086
• DOI: http://doi.org/10.17245/jkdsa.2010.10.2.190

Abstract

Difficult airway management including difficult intubation, difficult ventilation and difficult mask ventilation is a life threatening issue during anesthesia care. A 23-year-old woman with Treacher Collins syndrome was scheduled for distraction osteogenesis. She had hypoplasia of mandible and malar bone, bilateral deformities of auricles with partial deafness and antimongoloid slant of the palpebral fissures. A 56-year-old woman with mandibular hypoplasia due to childhood trauma was scheduled for distraction osteogenesis. She had a history of difficult intubation. We anticipated a difficult intubation and ventilation. Fiberoptic bronchoscopic guided awake intubation was selected for anesthesia induction. After intravenous injection of midazolam and remifentanil, 10% lidocaine pump spray on the pharyngolarynx with a direct laryngoscope and on the nasal canal. However fiberoptic bronchoscopic guided awake intubation was failed due to severe gag reflex. After intravenous injection of propofol and remifentanil using the target controlled infusion (TCI), mask ventilation was easily performed and, after intravenous injection of vecuronium, fiberoptic bronchoscopic guided intubation was easily performed using a wire reinforced endotracheal tube. The operation was completed successfully without any adverse events.

Keyword

Difficult Intubation; Fiberoptic guided Intubation; Treacher Collins syndrome; Mandibular hypoplasia

MeSH Terms

Airway Management*
Anesthesia
Congenital Abnormalities
Deafness
Female
Humans
Injections, Intravenous
Intubation*
Laryngoscopes
Lidocaine
Mandible
Mandibulofacial Dysostosis
Masks
Midazolam
Middle Aged
Osteogenesis, Distraction
Propofol
Reflex
Vecuronium Bromide
Ventilation
Young Adult
Zygoma
Lidocaine
Midazolam
Propofol
Vecuronium Bromide