Anesthetic management for a patient with severe mento-sternal contracture: difficult airway and scarce venous access -A case report-

Abstract

There are many problems in the anesthetic management of patients with scar contracture. In this case, a 41-year-old male with severe scar contracture on his face, neck, anterior chest, and both shoulders underwent surgery for resurfacing with flaps. We tried to awake fiberoptic orotracheal intubation with GlideScope® Video laryngoscope guide after surgical release of contracture under local anesthesia. We report a successful management of a patient with severe burn contracture achieved by combined effort of surgeons and anesthesiologists.

Craniofacial and maxillary anomalies: Anesthetic implications and management

“…These challenges get accentuated when such patients present for surgical intervention. [1][2][3][4][5][6] With the advent of modern craniofacial surgical interventions, these facial defects can be corrected to a large extent and can help the person to lead a normal life. Paul Tessier, the father of craniofacial surgery, has suggested various surgical techniques for repair of these defects involving a multidisciplinary approach involving plastic surgeon, neurosurgeon, maxillofacial surgeon, an ophthalmologist, an otolaryngologist, orthodontist, pedodontist, a pediatrician, speech specialist and Numerous congenital and traumatic cranio-maxillary malformations can be encountered in clinical practice, but we are limiting our discussion to the commonly faced anomalies.…”

The Lateral Position Improved Airway Patency in Anesthetized Patient With Burn-Induced Cervico-Mento-Sternal Scar Contracture

“…Difficult airway management is a challenge to anesthesiologists. Burn-induced neck and chest contractures restrict head and neck mobility ( 1 , 2 ), thereby making holding a face mask and chin lift and jaw thrust maneuvers very difficult.…”

“…Securing the airway is crucial for the management of general anesthesia especially in patients with burn-induced contracture, since burn-induced cervico-mento-sternal contracture poses considerable difficulty in airway management because of the functional and anatomical distortion such as limitation of neck extension and flexion ( 1 , 2 ). Lateral position decreases collapsibility of the passive pharyngeal airway in anesthetized patients ( 3 ).…”

Airway management in a pediatric patient with post-burn neck contracture using i-gel

“…Limitations of the mandible, neck, and mouth and the absence of anatomic markers in the neck may create these difficulties [3]. Blind intubation, contracture release under local anesthesia, and orotracheal intubation may be facilitated by the use of an LMA (Laryngeal Mask Airway) Fast Track, or the help of a fiberoptic laryngoscope, extracorporeal membrane oxygenization, and the Igel.…”