Management of a challenging airway in a child with muscular dystrophy and post‐tonsillectomy haemorrhage

Abstract

A 7-year-old male with congenital muscular dystrophy and a known difficult airway, presented to hospital in the early hours of the morning with severe secondary post-tonsillectomy bleeding requiring urgent surgery. After initial fluid resuscitation in the emergency department, he was transferred to the anaesthetic room. Gaseous induction of anaesthesia was commenced and tracheal intubation achieved using a glidescope TM after conventional laryngoscopy had failed. Haemostasis was achieved by the surgeons and the child was transferred to the paediatric intensive care unit post-operatively.We discuss the dilemmas regarding the use of volatile agents for induction and maintenance of anaesthesia in a child with muscular dystrophy, and the choice of intubation technique based on a limited history but known airway concerns. The case report also highlights the problems associated with the transition from paper based patient records to electronic records at our institution.