1 - Serviço de Anestesiologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, E.P.E.;
2 - Serviço de Anestesiologia, Hospital São Bernardo, Centro Hospitalar de Setúbal, E.P.E.
− 4rd Annual Congress of the European Society for Paediatric Anaesthesiology -Stresa 2012 (Poster).
Background and aims: Treacher Collins syndrome (TCS), also referred to as mandibulofacial dysostosis, is characterized by maxillary, zygomatic, and mandibular hypoplasia and known to be associated with difficult intubation. Neonates with TCS are at risk of upper airway obstruction, and may require the use of different techniques for a successfull intubation.
We report a case of a TCS neonate, in wich the laryngeal mask improved the airway obstruction and was useful as an airway intubator (conduit) for a flexible fiberoptic bronchoscope, over which a tracheal tube was passed [1]; [2].
Methods and results: A neonate 9 days old, male 2650 g weight, was admitted to neonatal intensive care unit, due to upper airway obstruction respiratory distress, relieved with a laryngeal mask airway (LMA) I-Gel® 1 insertion, after multiple unsuccessful attempts of orotraqueal intubation.
Although adequate oxigenation was achieved, ventilation was impaired due to air leak when in mechanical ventilatory support.
It was then decided to attempt intubation at the operating theatre, where difficult airway equipment was available.
Since good airway patency and oxigenation were maintained, different airway devices were tried out, starting with the simpler and most experienced ones, inhalationally deepening the patient throughout each attempt.
The techniques used were, respectively, blindly insertion of a Frova introducer through the LMA, followed by a combined Airtraq®/Frova devices. Those attempts were unachieved and finally a flexible fiberoptic was used. The patient was intubated with a 3,0 uncuffed tracheal tube railroaded by the fiberscope, through the LMA, at the second attempt.
Conclusions: In neonates with predicted difficult ventilation and intubation, a thoughtful airway management planning is mandatory.
Insertion of a laryngeal mask airway might be useful in facilitating oxygenation (by relieving upper airway obstruction) and fiberoptic bronchoscope remains an excellent choice for intubation in the difficult airway algorithm/non-emergency pathway.
Keywords: Treacher Collins syndrome, airway management, anesthesia.