Anesthesia and airway managements for emergency removal of esophageal foreign body in a trisomy 21 patient with mental retardation and predicted difficult airway

Abstract

Introduction: The typical manifestations of patients with a trisomy 21 syndrome are mental retardation and anatomical deformities of face and neck. In the available literature, all case reports regarding anesthetic management of mentally retarded patients have focused on elective surgeries. There is no report regarding anesthetic management of mentally retarded patients undergoing emergency surgery. Patient concerns: A 47-year-old woman with a mental retardation grade 2 by trisomy 21 syndrome suffered from an esophageal foreign body for 3 days and needed emergency removal of esophageal foreign body. The patient had a poor cooperation and obvious anatomical abnormalities of head and neck. Diagnoses: Difficult anesthesia and airway managements for emergency removal of esophageal foreign bodies in a trisomy 21patients with mental retardation and predicted difficult airways. Interventions: Combined use of an intubating supraglottic airway and the flexible bronchoscope-guided intubation after intravenous anesthesia induction. Outcomes: Effective airway was safely established and an esophageal foreign body was successfully removed by rigid esophagoscopy under anesthesia. The patient recovered smoothly without any complication. Lessons subsections as per style: When general anesthesia and emergency airway management are required in the patients with mental retardation and predicted difficult airways, a combination of the supraglottic airway and the flexible bronchoscope maybe a safe and useful choice for airway control.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

“…525 Case reports also observed intubation success for unanticipated and emergency airway patients when combination techniques were used (Category B4-B evidence). [526][527][528][529][530][531][532][533][534][535][536] The literature is insufficient to evaluate which of the above devices are most effective when attempted first after failed intubation, nor is the literature sufficient to evaluate the most effective order of devices to be used for attempted intubation of an unanticipated or emergency difficult airway.…”

Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: A retrospective study from three centers

“…Many studies in the literature evaluated the factors such as the type of foreign body, its dimensions, and the duration of retention in the esophagus as potential elements influencing the occurrence of complications. [ 6 , 12 , 13 , 16 ] Esophageal foreign bodies are an important clinical condition encountered in all age groups. According to the type of EFBs, there may be objects that can lead to life-threatening complications and be difficult to remove.…”

“…[ 5 ] They are also susceptible to eating disorders and are at risk of experiencing obstruction once incompletely chewed food, nuts, or animal bones are lodged in the esophagus, representing the narrowest segment of the upper gastrointestinal tract. [ 6 ]…”

“…[5] They are also susceptible to eating disorders and are at risk of experiencing obstruction once incompletely chewed food, nuts, or animal bones are lodged in the esophagus, representing the narrowest segment of the upper gastrointestinal tract. [6] In the present study, we aimed to evaluate our experience with EFBs in patients with mental retardation who underwent rigid esophagoscopy and esophageal surgery for foreign body retrieval.…”