Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.02.004
Brazilian Journal of Anesthesiology
Clinical Information

Difficult fiberoptic tracheal intubation in 1 month-old infant with Treacher Collins Syndrome

Intubação traqueal difícil com fibra óptica em bebê de um mês de idade com síndrome de Treacher Collins

Ricardo Fuentes; Juan Carlos De la Cuadra; Hector Lacassie; Alejandro González

http://dx.doi.org/10.1016/j.bjane.2015.02.004 Braz J Anesthesiol, vol.68, n1, p.87-90, 2018
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Abstract

Abstract Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al. Case report: An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Direct laryngoscopy for oral intubation failed to reveal the glottis. Fiberoptic intubation using nasal approach and using oral approach through a 1.5 size laryngeal mask airway were performed; however, both approach failed because the fiberscope loaded with a one 3.5 mm ID uncuffed tube was stuck inside the nasal cavity or inside the laryngeal mask airway respectively. Therefore, the laryngeal mask airway was keep in place and the fiberoptic intubation technique described by Ellis et al. was planned: the tracheal tube with the 15 mm adapter removed was loaded proximally over the fiberscope; the fiberscope was advanced under video-screen visualization into the trachea; the laryngeal mask airway was removed, leaving the fiberscope in place; the tracheal tube was passed completely through the laryngeal mask airway and advanced down over the fiberscope into the trachea; the fiberscope was removed and the 15 mm adapter was reattached to the tracheal tube. Conclusion: The fiberoptic intubation method through a laryngeal mask airway described by Ellis et al. can be successfully used in small infants with Treacher Collins Syndrome.

Keywords

Treacher Collins Syndrome, Difficult airway, Fiberoptic bronchoscope, Laryngeal mask airway, Infants

Resumo

Resumo Os recém-nascidos e crianças pequenas com malformação craniofacial podem ser muito difíceis ou impossíveis de ventilar por máscara ou de intubar. Gostaríamos de relatar a intubação com fibra óptica de um bebê com síndrome de Treacher Collins usando a técnica descrita por Ellis et al. Relato de caso: Uma criança de um mês de idade com síndrome de Treacher Collins foi programada para cirurgia mandibular sob anestesia geral endotraqueal. A laringoscopia direta para intubação oral não revelou a glote. A intubação com fibra óptica usando as abordagens nasal e oral por meio de máscara laríngea de tamanho 1,5 foi tentada, mas ambas as abordagens falharam porque o fibroscópio portando um tubo sem balonete de 3,5 mm ficou preso no interior da cavidade nasal ou dentro da máscara laríngea, respectivamente. Portanto, a máscara laríngea foi mantida no lugar e a técnica de intubação com fibra óptica descrito por Ellis et al. foi planejada: o tubo traqueal com o adaptador de 15 mm removido foi colocado proximalmente sobre o fibroscópio; o fibroscópio foi avançado na traquéia sob visualização em tela devídeo; a máscara laríngea foi removida, deixando o fibroscópio no lugar; o tubo traqueal foi passado completamente através da máscara laríngea e avançado para baixo sobre o fibroscópiona traquéia; o fibroscópio foi removido e o adaptador de 15 mm foi recolocado no tubo traqueal. Conclusão: O método de intubação com fibra óptica através de uma máscara laríngea descrito por Ellis et al. pode ser usado com sucesso em bebês com síndrome de Treacher Collins.

Palavras-chave

Síndrome de Treacher Collins, Via aérea difícil, Broncoscópio de fibra óptica

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