Current Trends in Surgical Airway Management of Neonates with Robin Sequence

Objective The purpose of this study was to examine the efficacy of tonguelip adhesion (TLA) in the management of clinically significant airway obstruction associated with Pierre Robin sequence. Design The records of all children admitted to The Children's Hospital of Philadelphia with a diagnosis of Pierre Robin sequence were reviewed. Charts were reviewed for birth data, diagnosis, preoperative airway management methods, and surgical intervention. Records of infants undergoing TLA were analyzed for timing of surgery, operative technique, postoperative complications, length of hospital stay, and treatment outcome. Results Over the 28-year period 1971 to 1999, 107 patients (47 boys, 60 girls) meeting the criteria for Pierre Robin sequence were admitted for treatment. Of these, 74 (69.2%) were successfully managed by positioning alone. Surgical management of the airway was performed in the remaining 33 (30.8%) patients, 29 of whom underwent TLA and 4 of whom underwent tracheostomy. Dehiscence of the adhesion occurred in five patients (17.2%), two of whom subsequently required tracheostomy. Within the group of patients who underwent mucosal adhesion alone, the dehiscence rate was 41.6%. When the adhesion included muscular sutures, however, dehiscence was not observed in any patient. Of the 24 patients in whom primary TLA healed uneventfully, airway obstruction was successfully relieved in 20 (83.3%). Failure of a healed TLA to relieve the airway obstruction resulted in conversion to a tracheostomy in four patients. Six patients who underwent TLA (20.7%) ultimately required a tracheostomy; five of these patients (83.3%) were syndromic. Of patients requiring preoperative intubation, 42.9% ultimately required tracheostomy. Conclusion TLA successfully relieves airway obstruction that is unresponsive to positioning alone in the majority of patients with Pierre Robin sequence and should therefore play an important role in the management of these infants.

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Surgical Airway Management in Pierre Robin Sequence: Is There a Role for Tongue-Lip Adhesion?

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569(2003)040<0013:samipr>2.0.co;2 ◽

2003 ◽

Vol 40 (1) ◽

pp. 13-18 ◽

Cited By ~ 74

Author(s):

Richard E. Kirschner ◽

David W. Low ◽

Peter Randall ◽

Scott P. Bartlett ◽

Donna M. McDonald-McGinn ◽

...

Keyword(s):

Airway Management ◽

Pierre Robin Sequence ◽

Robin Sequence ◽

Surgical Airway ◽

Pierre Robin

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Faculty Opinions recommendation of Airway management in two of newborns with Pierre Robin Sequence: the use of disposable vs multiple use LMA for fiberoptic intubation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1057755.510698 ◽

2006 ◽

Author(s):

Francis Veyckemans

Keyword(s):

Airway Management ◽

Fiberoptic Intubation ◽

Pierre Robin Sequence ◽

Multiple Use ◽

Robin Sequence ◽

Pierre Robin

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Faculty Opinions recommendation of Emergency surgical airway management in Denmark: a cohort study of 452 461 patients registered in the Danish Anaesthesia Database.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726585490.793521756 ◽

2016 ◽

Author(s):

Michael Aziz

Keyword(s):

Cohort Study ◽

Airway Management ◽

Surgical Airway

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Emergency Surgical Airway Algorithm for Difficult Airway Management During the COVID-19 Pandemic

Otolaryngology ◽

10.1177/0194599820986563 ◽

2021 ◽

pp. 019459982098656

Author(s):

Soham Roy ◽

John D. Cramer ◽

Carol Bier-Laning ◽

Patrick A. Palmieri ◽

Christopher H. Rassekh ◽

...

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Difficult Airway Management ◽

Surgical Airway

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Emergency airway management in Pierre Robin Sequence, our nightmare experiences

Trends in Anaesthesia and Critical Care ◽

10.1016/j.tacc.2020.10.003 ◽

2020 ◽

Author(s):

Soumya Sarkar ◽

Anudeep Jafra ◽

Preethy Mathew

Keyword(s):

Airway Management ◽

Pierre Robin Sequence ◽

Emergency Airway Management ◽

Emergency Airway ◽

Robin Sequence ◽

Pierre Robin

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Surgical airway management

Cases in Emergency Airway Management ◽

10.1017/cbo9781139941471.028 ◽

2015 ◽

pp. 207-216

Author(s):

Aaron E. Bair

Keyword(s):

Airway Management ◽

Surgical Airway

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Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

PLoS ONE ◽

10.1371/journal.pone.0250369 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250369

Author(s):

Andreas Moritz ◽

Luise Holzhauser ◽

Tobias Fuchte ◽

Sven Kremer ◽

Joachim Schmidt ◽

...

Keyword(s):

Airway Management ◽

Success Rate ◽

Failure Rate ◽

Dental Trauma ◽

Previous Experience ◽

Pierre Robin Sequence ◽

Vocal Cords ◽

Extensive Experience ◽

Robin Sequence ◽

Pierre Robin

Background Video laryngoscopy is an effective tool in the management of difficult pediatric airway. However, evidence to guide the choice of the most appropriate video laryngoscope (VL) for airway management in pediatric patients with Pierre Robin syndrome (PRS) is insufficient. Therefore, the aim of this study was to compare the efficacy of the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a nonangulated Miller blade (C-MAC® Miller) and a conventional Miller laryngoscope when used by anesthetists with limited and extensive experience in simulated Pierre Robin sequence. Methods Forty-three anesthetists with limited experience and forty-three anesthetists with extensive experience participated in our randomized crossover manikin trial. Each performed endotracheal intubation with the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a Miller blade and the conventional Miller laryngoscope. “Time to intubate” was the primary endpoint. Secondary endpoints were “time to vocal cords”, “time to ventilate”, overall success rate, number of intubation attempts and optimization maneuvers, Cormack-Lehane score, severity of dental trauma and subjective impressions. Results Both hyperangulated and nonangulated VLs provided superior intubation conditions. The Glidescope® Core™ enabled the best glottic view, caused the least dental trauma and significantly decreased the “time to vocal cords”. However, the failure rate of intubation was 14% with the Glidescope® Core™, 4.7% with the Miller laryngoscope and only 2.3% with the C-MAC® Miller when used by anesthetists with extensive previous experience. In addition, the “time to intubate”, the “time to ventilate” and the number of optimization maneuvers were significantly increased using the Glidescope® Core™. In the hands of anesthetists with limited previous experience, the failure rate was 11.6% with the Glidescope® Core™ and 7% with the Miller laryngoscope. Using the C-MAC® Miller, the overall success rate increased to 100%. No differences in the “time to intubate” or “time to ventilate” were observed. Conclusions The nonangulated C-MAC® Miller facilitated correct placement of the endotracheal tube and showed the highest overall success rate. Our results therefore suggest that the C-MAC® Miller could be beneficial and may contribute to increased safety in the airway management of infants with PRS when used by anesthetists with limited and extensive experience.

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Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome

Anesthesia Progress ◽

10.2344/0003-3006-61.3.103 ◽

2014 ◽

Vol 61 (3) ◽

pp. 103-106 ◽

Cited By ~ 4

Author(s):

Yuri Hase ◽

Nobuhito Kamekura ◽

Toshiaki Fujisawa ◽

Kazuaki Fukushima

Keyword(s):

Airway Management ◽

Cervical Vertebrae ◽

Anesthetic Management ◽

Preoperative Evaluation ◽

Fatal Outcome ◽

Laryngeal Edema ◽

Airway Control ◽

First Choice ◽

Surgical Airway ◽

Preoperative Examination

Abstract Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.

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