Anesthesia for a neonate with persistent buccopharyngeal membrane and unilateral choanal atresia

Abstract

We report our anesthetic management of a neonate who presented with complete persistent buccopharyngeal membrane and unilateral choanal atresia, and underwent examination under anesthesia. Maintaining airway patency and spontaneous respiration were our priority. Intravenous propofol was used to maintain adequate anesthetic depth for flexible laryngotracheoscopy and nasotracheal intubation through the only patent passage. We encountered problems of bradycardia and hypotension. Tracheostomy was performed. Definitive management of the persistent buccopharyngeal membrane was carried out on day 14.

Oropharyngeal atresia in a preterm infant: A case report and review of the literature

“…Oropharyngeal atresia is a rare condition, with 15 previous reports in the literature, 5 of which were (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13]. This condition has also previously been reported as ''persistent buccopharyngeal membrane'' in the literature.…”

“…Two cases of oropharyngeal atresia have been described in association with costovertebral and auricular anomalies [1,2]. Cardiac anomalies have also been described including atrial septal defect in two cases, patent ductus arteriosus, and transposition of the great arteries [5,7,9,10]. One case was associated with unilateral choanal atresia, further complicating airway management in that patient [7].…”

Persistent buccopharyngeal membrane: Report of a case and review of the literature

“…Persistence of the buccopharyngeal membrane inhibits the fetus from swallowing amniotic fluid as in esophageal and duodenal atresia, all of which result in polyhydramnios. Seven patients, including ours, presented with cardiac anomalies which potentially complicate oxygenation issues until addressed [4,6,8,11,14,16]. A list of congenital anomalies associated with each patient is presented in Table 2.…”

“…Eight patients were able to breathe easily and presented between 1 day and 3 months of age with dysphagia [2,8,[18][19][20][21]. Physical examination of these patients demonstrated either a partial or total BPM.…”

“…Associated congenital anomalies Verma Transposition of great arteries, patent ductus arteriosus, atrial septal defect Lee [4] Ventricular septal defect, patent ductus arteriosus, vertebral anomalies Kara [3] None Takahashi [5] None Tan [6] Atrial septal defect Ooi [7] None Lim [8] Atrial septal defect, unilateral choanal atresia Thauvin [9] Hypomandibular faciocranial dysostosis Kantaputra [10] Aglossia, micrognathia, microcephaly, absence of mandibular teeth Bent [11] Transposition of great arteries Agarwal [2] None Agarwal [2] None Ludman [12] Hypomandibular faciocranial dysostosis, bicornuate uterus Gartlan [13] Micrognathia, microglossia Schimke [14] Hypomandibular faciocranial dysostosis, patent ductus arteriosus Flannery [15] Mandibulofacial dysostosis, downslanting palpebral fissures, epicanthal folds, broad nasal bridge, costovertebral anomalies Neidich [16] Severe first branchial arch anomalies, atrial septal defect Arcand [17] None Hoffman [18] None Chandra [19] None Seghers [20] Auricular and vertebral anomalies Longacre [21] None Fridenberg [22] None…”