Airway management for intubation in newborns with pierre robin sequence

Abstract

This series demonstrates that endotracheal intubation is safe and effective in PRS newborns. In patients who failed intubation with direct laryngoscopy, intubation over a flexible fiberoptic bronchoscope provided a reliable alternative method. Although airway management in PRS newborns poses a significant challenge, experienced otolaryngologists and anesthesiologists can successfully manage these difficult airway cases.

Airway Management in Neonates with Pierre Robin Syndrome along with Mobius Syndrome and Platoglossal Fusion

“…In the unfortunate event of inability to ventilate after induction of anesthesia, emergent bronchoscopy with rigid bronchoscope may be the only option to ventilate a patient if direct laryngoscopy and intubation failed [2,3,5]. Emergency tracheostomy and extracorporeal membrane oxygenation (in patients >2 kg and older than 34 weeks gestational age) can be the last resorts in a pediatric "cannot ventilate, cannot intubate" situation [2,3,5,7].…”

“…The major challenge for the anesthesiologist in these patients is airway management due to glosssoptosis causing obstructive sleep apnea (OSA). This airway obstruction can exist at multiple levels and result in loss airway patency and death [2,4,6,7]. Micrognathia and cleft palate add further complications to airway management, both in mask ventilation and in intubation [1,3] and limited oral opening can further intensify the challenges of airway management.…”

Neonatal mandibular distraction osteogenesis

“…In emergent cases of airway obstruction, the laryngeal mask airway (LMA) may be used as an effective bridge to more definitive management. 4 For those neonates who are not in acute airway distress, evaluation should begin with a comprehensive history and physical examination to assess for any other abnormalities. Additional dysmorphic features, neurologic impairment, and cardiopulmonary dysfunction should be noted, as PRS can be associated with several conditions, including stickler and velocardiofacial syndrome.…”

“…The patient is then preferentially nasotracheally intubated over a flexible bronchoscope. 4 The bed is turned 1801 with the anesthesia circuit over the anterior chest to avoid potential nasal alar necrosis and to allow for easy access to the lower body by the anesthesia team. Intravenous cefazolin (50 mg/kg, up to 1 g) is administered at this time.…”

Airway Management for Pierre Robin Sequence: An Anesthetic Challenge

“…[1] Marston AP et al (2012) conducted a study on 23 neonates with PRS demonstrated that endotracheal intubation could be done safely using conventional laryngoscopy in 37 % patients and in rest 63 % flexible fibreoptic bronchoscopy assisted intubation was used successfully. [10] Tariq Hayat Khan et al (2013) reported the intubation of a two year old child with PRS by using Air-Q intubating laryngeal mask airway. [11] Parul Mullick et al (2005) reported a case in which LMA insertion along with the use of a modified adult intubating stylet facilitated blind endotracheal intubation in a twenty one month old boy with Pierre Robin syndrome posted for cleft palate repair.…”