Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures. Our findings emphasize the importance of a preplanned algorithm for airway control in secure airway management and feasibility of awake FFB intubation in a pediatric patient with burn contracture of the neck during anesthesia induction for reconstructive surgery. Application of FFB intubation based on a stepwise approach including a trial phase prior to operation day seemed to increase the chance of a successful intubation in our patient in terms of technical expertise and increased patient cooperation and tolerance by enabling familiarity with the procedure.
In this chapter the essential aspects of tracheoesophageal fistula repair are discussed. Subtopics include the classic signs of symptoms of this disease in the pediatric patient as well as airway management. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. In the preoperative section the various types (A-F) of tracheoesophageal fistula are outlined and assessment of the patient’s respiratory status reviewed. Issues discussed in relation to intraoperative management include monitors used, inhalation induction, intubation, and positioning of the patient. Postoperative concerns discussed include extubation of the patient and complications of tracheoesophageal fistula repair.
Tracheal bronchus is an ectopic bronchus almost arising from the right side of the tracheal wall above the carina. The incidence of a tracheal bronchus is reported as 0.1 to 3%. We experienced a patient with tracheal bronchus that was incidentally found at induction of anesthesia. Endotracheal intubation in a patient with tracheal bronchus might cause obstruction of the tracheal bronchus, although in this case, ventilation was not impaired.
In this chapter several topics related to managing pediatric anesthesia are discussed. Subtopics include managing patients with the CHARGE syndrome, tetralogy of Fallot, Treacher-Collins syndrome, and malignant hyperthermia. Also addressed is anesthetia management in a pediatric patient with pyloric stenosis. Airway management in pediatric patients is also discussed, including induction. Differences between an omphalocele and a gastroschisis are outlined, and closure of an omphalocele in an infant is addressed. Each scenario is presented as a short, three- to four-question additional topic.
Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure Airway Management for Reconstructive Surgery in a Pediatric Patient with Burn Contracture of the Neck