Airway Management for Pierre Robin Sequence: An Anesthetic Challenge


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Volume :

3

Issue :

2

Abstract :

Pierre Robin Sequence (PRS) consisting of micrognathia, glossoptosis and cleft palate present with airway obstruction and feeding difficulties with or without other congenital anomalies. These patients come into category of difficult ventilation and difficult intubation. We present a case report of a 3years old female child, weighing 9.5kg, suffering from PRS with right lacrimal sac abscess and history of recurrent failed intubation, feeding difficulty along with failure of development of speech was posted for endoscopic DCR. Thorough preoperative airway assessment was done using COPUR scale and NCCT neck for detail airway dimension. Use of silicone round mask and two hand jaw thrust were beneficial for ventilation of the child with receding chin. The spontaneous ventilation was maintained till the airway was secured by performing inhalational induction with Sevoflurane followed by intubation using paraglossal approach of direct laryngoscopy with Miller’s blade 1 and uncuffed ETT no 4.PRS patients are at risk of postoperative airway obstruction and respiratory depression. Anticipating this catastrophe steroid was administered intra-operatively, use of long acting opioids was avoided and patient was kept under observation in PACU for 24 hours after extubation.

Keyword :

Airway obstruction, Difficult ventilation, Difficult intubation, Paraglossal Technique, Pierre Robin Sequence.
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