Airway management for rigid bronchoscopy via a freshly performed tracheostomy in a child with Goldenhar syndrome

Introduction: Goldenhar syndrome is an oculoauriculovertebral spectrum attributed to the developmental anomalies of the first and second brachial arches. Its typical presentation in children with hemifacial microsomia poses a dual challenge for the anaesthesiologist on account of difficult airway often compounded with systemic abnormalities. Case report: We describe a case report wherein a 5 year female presented to the oculoplastic clinic of our hospital for surgical removal of limbal dermoid under general anaesthesia. Airway examination revealed classical facial asymmetry with underdevelopment of jaw bone coupled with protruding incisors. A predicted difficult airway, more so in a child led us to choose an anaesthesia technique with preservation of spontaneous breathing and planned use of supraglottic device in the form of an I Gel for airway management. Conclusion: The aim of this case report is to highlight the anaesthetic implications of this not so uncommon entity presenting to ophthalmology and ENT clinics. A thorough preoperative assessment, adequate preparedness and alternative plans are keys for successful airway management in such syndromic children. Keywords: Goldenhar syndrome, hemifacial microsomia, I Gel

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Airway Management and Anesthesia for Tracheal Resection in a 68-Year-Old: 3 Airways for the Price of 1

Case Reports in Anesthesiology ◽

10.1155/2021/5548105 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Klint J. Smart ◽

Iwan P. Sofjan

Keyword(s):

Airway Management ◽

Balloon Dilation ◽

Airway Device ◽

Rigid Bronchoscopy ◽

Supraglottic Airway ◽

Tracheal Resection ◽

Intravenous Anesthesia ◽

Prolonged Intubation ◽

Persistent Symptoms ◽

Evaluation Phase

Subglottic tracheal stenosis can occur after prolonged intubation or tracheostomy. This stenosis can become severe and causes symptoms refractory to endoscopic interventions that require tracheal resection. This surgery presents unique anesthetic issues due to the airway anatomy, physiology, and shared airway management with the surgical team. We present the case of a 68-year-old patient who underwent cervical tracheal resection and reconstruction due to persistent symptoms despite balloon dilation and medical management with oxygen and heliox. Our anesthesia management involved several techniques that allowed the safe completion of this procedure. Firstly, we started the airway management with a combined size 4 Ambu® AuraStraight™ (Denmark) supraglottic airway device and flexible bronchoscopy to allow localization of the stenosis and dilation before endotracheal tube (ETT) placement. The conventional approach for this endoscopic evaluation phase is to use rigid bronchoscopy. Secondly, we used prior CT images to help guide our ETT tube size selection. Thirdly, we used total intravenous anesthesia during most of the procedure because of the intermittent apnea necessary to complete the tracheal resection. Lastly, extubation had to be done very carefully to minimize excessive patient neck movement and avoid any reintubation. Both could lead to a catastrophe with the newly reconstructed trachea.

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Airway management using the pediatric GlideScope® in a child with Goldenhar syndrome and atypical plasma cholinesterase

Pediatric Anesthesia ◽

10.1111/j.1460-9592.2006.02149.x ◽

2007 ◽

Vol 17 (5) ◽

pp. 484-487 ◽

Cited By ~ 47

Author(s):

ANDREW D. MILNE ◽

ANDREA M. DOWER ◽

THOMAS HACKMANN

Keyword(s):

Airway Management ◽

Plasma Cholinesterase ◽

Goldenhar Syndrome

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Goldenhar Syndrome

10.1093/med/9780190685157.003.0058 ◽

2018 ◽

Author(s):

Amy Soleta ◽

Joelle Karlik

Keyword(s):

Airway Management ◽

Cervical Vertebrae ◽

Pulmonary Complications ◽

Goldenhar Syndrome ◽

Thoracic Insufficiency Syndrome ◽

Renal Malformations ◽

Vertebral Anomalies ◽

Difficult Ventilation ◽

Insufficiency Syndrome ◽

Degrees Of Severity

Goldenhar syndrome (also known as oculo-auriculo-vertebral spectrum, facio-auriculo-vertebral syndrome, and Goldenhar-Gorlin syndrome) is caused by fetal growth disturbances of the first two brachial clefts. Diagnostic criteria include eye, ear, mandibular, and/or vertebral anomalies. These patients may also have cardiac and renal malformations with varying degrees of severity. Airway management for Goldenhar patients may include difficult ventilation and intubation, which may become increasingly difficult with age. Vertebral anomalies including fused cervical vertebrae and/or cervical instability further complicate airway management. Pulmonary complications occur due to congenital malformations and scoliosis, which can lead to thoracic insufficiency syndrome. This chapter discusses genetics, presentation, and management of Goldenhar syndrome.

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