Airway management of a pediatric patient with cervical cystic hygroma can be challenging as the large neck mass may extend in the oral cavity, result in tracheal deviation, and cause possible upper airway obstruction. This is a case of a 4-year-old female admitted due to sudden enlargement of neck mass associated with dysphagia and sialorrhea. Patient was intubated under sedation while maintaining spontaneous ventilation with a pediatric flexible fiberoptic scope through a nasopharyngeal airway serving as a passage guide for ease of scoping and a protective device against trauma.
Lymphangioma, Cystic ; Airway Management ; Intubation

Klippel-Feil Syndrome (KFS) continues to pose significant challenges for anesthesiologists. Beyond the expected complexities of managing difficult airways in these patients, they often present with systemic anomalies that can elevate the risk of morbidity during surgeries conducted under anesthesia. Furthermore, laparoscopic procedures bring about additional physiologic changes that must be taken into consideration when planning the anesthetic care for these individuals. This report details the anesthetic management of a 29-year-old female diagnosed with Klippel-Feil Syndrome (KFS) and concomitant Müllerian duct aplasia-Renal agenesis-Cervicothoracic Somite dysplasia (MURCS) as well as Chiari Type 1 Malformation, who underwent a successful pelvic laparoscopic surgery. The airway was secured through awake fiberoptic-guided intubation while general anesthesia was maintained with a combination of sevoflurane inhalation and remifentanil infusion. Intraoperatively, the team prioritized neuroprotection, lung-protective ventilation strategies, and renal preservation measures. The anesthetic management of patients with KFS necessitates a comprehensive assessment of their anomalies. Incorporating these considerations into the anesthetic management will help mitigate the procedure's adverse effects and lead to favorable patient outcomes.
Anesthesia ; Airway Management ; Klippel-Feil Syndrome ; Laparoscopy

INTRODUCTION: General anaesthesia is associated with higher maternal morbidity and mortality when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for Caesarean delivery at a high-volume obstetric hospital in Singapore. METHODS: All parturients who underwent Caesarean delivery under general anaesthesia from 2013 to 2016 were identified and their medical records were reviewed to extract pertinent data. Difficult intubation was defined as 'requiring more than one attempt at intubation or documented as such, based on the opinion of the anaesthetist'. A failed intubation was defined as 'inability to intubate the trachea, with subsequent abandonment of intubation as a means of airway management'. RESULTS: Records of 660 Caesarean sections under general anaesthesia were extracted. The mean age of the parturients was 32.1 ± 5.5 years and the median body mass index was 27.5 (interquartile range 24.6-31.1) kg/m². Rapid sequence induction with cricoid pressure was employed for all patients, with thiopentone and succinylcholine being administered for 91.2% and 98.1% of patients, respectively. There were 33 difficult intubations among 660 patients, yielding an incidence of 5.0%. Junior trainees performed about 90% of all intubations and 28 (84.8%) out of 33 difficult intubations. Repeat intubations were performed by senior residents/fellows (57.1%) and consultants (14.3%). No instance of failed intubation was reported. CONCLUSION The local incidence of difficult obstetric intubation was one in 20. No failure of intubation was observed.
Adult ; Airway Management ; Anesthesia, General ; Cesarean Section ; Female ; Humans ; Intubation, Intratracheal ; Pregnancy ; Retrospective Studies

An anticipated difficult airway requires careful planning and teamwork among the anesthesiologists and the surgical team. This paper reports the airway management of a 7-year-old female scheduled for LASER excision of a huge, obstructing laryngeal neoplasm. Initial attempts to secure the airway with the patient minimally sedated using a C-MAC Video Laryngoscope (C-MAC) and a traditional intubating stylet failed. Successful tracheal intubation was achieved when C-MAC was combined with a pediatric Bonfils Intubating Fiberscope (BIF) with the patient under general anesthesia.

Ankyloblepharon-ectodermal dysplasia-clefting (AEC) syndrome is an ectodermal dysplasia presenting with cleft lip or palate and congenital filiform eyelid fusion. This is a case report of a 1-year and 6-month-old girl with AEC syndrome presenting with temporomandibular joint ankylosis who underwent release of temporomandibular joint ankylosis, coronoidectomy, bilateral cheiloplasty, Tajima rhinoplasty, and repair of lower lip pits under general anesthesia. Fiberoptic nasotracheal intubation was done successfully using a two-stage technique originally described by Stiles. As necessitated by the surgical plan, video laryngoscope guidance was subsequently used to facilitate the conversion from nasotracheal to orotracheal intubation.

Fiberoptic-guided intubation (FOI) has been an indispensable component of difficult airway management especially in instances where anatomical limitations precluded use of conventional direct laryngoscopy. Its use, however, is not without risks.

This paper presents a 4-year-old female with a limited mouth opening scheduled for an elective oral commissurotomy who developed signs and symptoms of tension pneumothorax immediately following a successful fiberoptic nasotracheal intubation. Passive insufflation of high-flow oxygen through a flexible fiberoptic bronchoscope preloaded with a tight-fitting endotracheal tube led to accumulation of air. This caused lung hyperinflation and subsequently, pneumothorax.

Objective: To explore the effect of perioperative airway management based on the concept of enhanced recovery after surgery (ERAS) on the improvement of preoperative pulmonary function in patients with aspirin intolerance triad (AIT). Methods: Thirty patients with AIT (including 13 males and 17 females, aged from 29 to 75 years old) for sinus surgery from January 2018 to December 2019 were selected, 172 patients (including 105 males and 67 females, aged from 17 to 83 years old) with chronic rhinosinusitis with nasal polyps (CRSwNP) without lower airway disease were selected by random number table at the same period, and their clinical data and preoperative pulmonary function were analyzed and compared retrospectively. FEV₁%pred<80% after bronchodilation test was considered as high risk for surgery. Preoperative evaluation and standardized drug intervention were applied in patients with pulmonary function abnormalities at risk for surgery, and improvement of preoperative pulmonary function and tolerability to general anesthesia surgery in the two groups were evaluated. All the statistical analyses were conducted using SPSS 22.0. Results: The main pulmonary function indexes (FEV₁%pred, FEV₁/FVC%pred, FEF₅₀%pred, FEF₇₅%pred, MMEF%pred) in AIT group decreased significantly than those in CRSwNP group (t values were 10.882, 10.506, 9.141, 10.182, 9.099, respectively, all P<0.001). At admission 86.7% (26/30) patients in the AIT group and 11.6% (20/172) patients in CRSwNP group had high surgical risk for lung function, with significantly difference (χ² = 81.788, P<0.05); after 3 days with individualized drug intervention, 57.7% (15/26) patients in AIT group reached the standard for surgery, which was significantly less than 90.0% (18/20) patients in CRSwNP group (χ²=4.335,P<0.05); and after 6 days with drug intervention, the patients who reached the standard for surgery in pulmonary function accounted for 92.3% (24/26) in the AIT group and 100% (20/20) in the CRSwNP group. FEV₁%pred in the two groups before surgery were significantly improved compared with those at admission respectively ((90.00±6.32)% vs. (64.79±13.60)%,t value was 10.110 in AIT group; (91.65±11.86)% vs. (76.40±9.35)%, t value was 9.346 in CRSwNP group; all P<0.05), and also FEV₁/FVC%pred, FEF₅₀%pred, FEF₇₅%pred and MMEF%pred were all significantly improved (all P<0.05). Surgery was completed successfully in the two groups of patients with lung function meeting the surgical standard, and no intraoperative or postoperative airway adverse events occurred. Conclusion: AIT patients have high airway risk for sinus surgery due to poor pulmonary function. Standardized airway management based on the concept of ERAS can improve the pulmonary function of patients, and decrease the incidence of perioperative airway adverse events.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Airway Management ; Aspirin ; Enhanced Recovery After Surgery ; Female ; Humans ; Lung/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

PURPOSE: Asthma control in older asthmatics is often less effective, which may be attributed to small airway dysfunction and poor inhalation technique. We compared the efficacy of 2 inhalers (fluticasone propionate/formoterol treatment using a pressurized metered-dose inhaler [p-MDI group] vs. fluticasone propionate/salmeterol treatment using a dry powder inhaler [DPI group]) in older asthmatics.METHODS: We conducted a 12-week, randomized, open-label, parallel-designed trial in older patients (over 55 years old) with moderate-to-severe asthma, and compared the efficacy and safety for asthma control between the 2 groups. Subgroup analyses on disease duration and air trapping were performed. Clinical parameters, including changes in lung function parameters, inhaler technique and adherence, were compared with monitoring adverse reactions between the 2 groups.RESULTS: A total of 68 patients underwent randomization, and 63 (30 in the p-MDI group and 33 in the DPI group) completed this study. The p-MDI group was non-inferior to the DPI group with regard to the rate of well-controlled asthma (53.3% vs. 45.5%, P < 0.001; a predefined non-inferiority limit of 17%). In subgroup analyses, the proportion of patients who did not reach well-controlled asthma in the p-MDI group was non-inferior to that in the DPI group; the difference was 12.7% among those with a longer disease duration (≥ 15 years) and 17.5% among those with higher air-trapping (RV/TLC ≥ 45%), respectively (a predefined non-inferiority limit of 17%, P < 0.001). No significant differences were observed in lung function parameters, inhalation techniques, adherence and adverse reactions between the 2 groups.CONCLUSION: These results suggest that the p-MDI group may be comparable to the DPI group in the management of older asthmatics in aspects of efficacy and safety.
Airway Management ; Asthma ; Dry Powder Inhalers ; Fluticasone ; Humans ; Inhalation ; Lung ; Medication Adherence ; Metered Dose Inhalers ; Nebulizers and Vaporizers ; Random Allocation

Since the outbreak of COVID-19, the prevention and control of nosocomial infections has been highly valued. Airway management, including endotracheal intubation, extubation, and suction, has been considered as the high-risk virus-spreading procedures, which can put the health providers at a high risk of nosocomial infections. As hospitals at all levels will gradually resume their routine medical work, effective managements for the airway of the silent asymptomatic carriers and patients with delayed symptoms, treatment for severe patients, and prevention of cross infection in hospital have become the focus for the current prevention and control of nosocomial infections. Under the guidance of partitioned and graded prevention and differential control strategies at this stage, we comprehensively analyzed four main intubation methods used in the current clinical work including rapid sequence intubation, laryngeal mask insertion, intubation guided by video flexible intubating scope and awake tracheal intubation. Furthermore, we discussed and summarized intubation and protection strategies for 3 categories of patients during the COVID-19 pandemic, providing evidence for protecting medical stuff in operating room and ICU against severe acute respiratory syndrome coronavirus 2 infection.
Airway Management ; Betacoronavirus ; Coronavirus Infections ; prevention & control ; therapy ; Cross Infection ; prevention & control ; Humans ; Intubation ; Laryngeal Masks ; Pandemics ; prevention & control ; Pneumonia, Viral ; prevention & control ; therapy

CHARGE syndrome is a rare genetic disorder with CHD7 gene mutation. CHARGE is an acronym for coloboma (C), heart disease (H), atresia of choanae (A), retardation of growth (R), genitourinary malformation (G), and ear abnormalities (E). Patients with CHARGE syndrome need to undergo many surgeries due to their various congenital anomalies. Since airway abnormalities frequently accompany CHARGE syndrome, general anesthesia remains a challenge. Here we report a case of difficult intubation in a 35-month-old boy with CHARGE syndrome during general anesthesia and the experience of successful intubation using D-blade of C-MAC® video laryngoscope.
Airway Management ; Anesthesia, General ; CHARGE Syndrome* ; Child* ; Child, Preschool ; Coloboma ; Ear ; Heart Diseases ; Humans ; Intubation* ; Laryngoscopes* ; Male ; Nasopharynx ; Pediatrics