Chen JX, Shi XL, Liang CS, Ma XG, Xu L. Anesthesia management in a pediatric patient with complicatedly difficult airway: A case report. World J Clin Cases 2023; 11(11): 2482-2488 [PMID: 37123316 DOI: 10.12998/wjcc.v11.i11.2482]
Corresponding Author of This Article
Liang Xu, MD, Director, Doctor, Professor, Department of Anesthesiology, Shenzhen Children's Hospital, No. 7019 Yitian Road, Futian District, Shenzhen 518038, Guangdong Province, China. leonnel@msn.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jia-Xiang Chen, Xiao-Li Shi, Chang-Sheng Liang, Xing-Gang Ma, Liang Xu, Department of Anesthesiology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
Jia-Xiang Chen, Department of Anesthesiology, Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518038, Guangdong Province, China
Author contributions: Chen JX collected the medical records of the patient; Shi XL and Liang CS took responsibility for investigation and data curation; Chen JX, Ma XG, and Xu L drafted and revised the manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s guardian for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liang Xu, MD, Director, Doctor, Professor, Department of Anesthesiology, Shenzhen Children's Hospital, No. 7019 Yitian Road, Futian District, Shenzhen 518038, Guangdong Province, China. leonnel@msn.com
Received: December 17, 2022 Peer-review started: December 17, 2022 First decision: January 3, 2023 Revised: January 31, 2023 Accepted: March 21, 2023 Article in press: March 21, 2023 Published online: April 16, 2023 Processing time: 110 Days and 5.6 Hours
Abstract
BACKGROUND
Reports on perioperative anesthesia management in pediatric patients with difficult airways are scarce. In addition to relatively more difficulties in the technique of endotracheal intubation, the time for manipulation is restricted compared to adults. Securing the airways safely and avoiding the occurrence of hypoxemia in these patients are of significance.
CASE SUMMARY
A 9-year-old boy with spastic cerebral palsy, severe malnutrition, thoracic scoliosis, thoracic and airway malformation, laryngomalacia, pneumonia, and epilepsy faced the risk of anesthesia during palliative surgery. After a thorough preoperative evaluation, a detailed scheme for anesthesia and a series of intubation tools were prepared by a team of anesthesiologists. Awake fiberoptic intubation is the widely accepted strategy for patients with anticipated difficult airways. Given the age and medical condition of the patient, we kept him sedated with spontaneous breathing during endotracheal intubation. The endotracheal intubation was completed on the second attempt after the failure of the first effort. Fortunately, the surgery was successful without postoperative complications.
CONCLUSION
Dealing with difficult airways in the pediatric population, proper sedation allows time to intubate without interrupting spontaneous breathing. The appropriate endotracheal intubation method based on the patient’s unique characteristics is the key factor in successful management of these rare cases.
Core Tip: A loss of control of the pediatric airway can result in catastrophic consequences if not addressed promptly. Spastic cerebral palsy is often associated with complicated airways in pediatric patients, which can be classified as difficult intubations of anticipated difficult airways. Sedation with spontaneous breathing and fiberoptic bronchoscope-guided endotracheal intubation is a valuable method for such patients. Herein, we describe the entire process of airway management and analyze the failure of the first intubation attempt.
