Airway Management for Pierre Robin Sequence: An Anesthetic Challenge

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.

Effective intubation technique to manage the airway obstruction in A case of Pierre Robin sequence: A case report

“… 15 Sonwane et al performed paraglossal intubation with Miller's blade 1 to manage the PRS airway obstructions and it was successful. 16 In Marson et al's study on 33 neonates, 37% of the cases were managed with endotracheal intubation, and 63% were managed with fiberoptic bronchoscope. 11 In Hayat Khan et al's study, successful intubation was done with the help of air‐Q intubating laryngeal mask airway (ILMA).…”

“…Zhang et al used finger guide intubation to reduce severe upper airway obstruction in 2 PRS infants 15 . Sonwane et al performed paraglossal intubation with Miller's blade 1 to manage the PRS airway obstructions and it was successful 16 . In Marson et al's study on 33 neonates, 37% of the cases were managed with endotracheal intubation, and 63% were managed with fiberoptic bronchoscope 11 .…”

Accidental extubation in a patient with Pierre-Robin syndrome: a case report

“…1 Anesthesiologist responsible for a patient with PRS should have an experience with a difficult airway management, be familiar with current life support algorithms and plan how to approach these patients in advance. 2 The occurrence of accidental extubation, tough well studied in the intensive care area, is still not well investigated in the context of perioperative care. It is a rare event (< 0.3%), 3 still it can have catastrophic consequences anytime in one's clinical life.…”

Endotracheal intubation using a three-dimensional printed airway model in a patient with Pierre Robin sequence and a history of tracheostomy -a case report-

“…All patients with PRS have airway obstruction, as it is a requirement for the clinical diagnosis [ 1 ]. Although airway obstruction tends to improve with age, the very difficult intubation with direct laryngoscopy should be always considered in the pre-anesthesia plan [ 5 ]. In the patients with PRS, fiberoptic intubation is the gold standard, but numerous other approaches have been used successfully including direct video laryngoscopy and fiberoptic intubation via laryngeal mask airway [ 4 ].…”