Pre-anesthetic evaluation can play a crucial role in the determination of airway management in a child with oropharyngeal tumor

Abstract

We experienced a case of a huge hemangioma occupying the oropharyngeal space in an 11-year-old child. Although urgent surgical tracheostomy under local anesthesia was suggested initially, medical interview and findings of computerized tomography and fiberoptic laryngoscopy revealed that the airway of the patient was relatively stable when she was in the semi-left decubitus position. General anesthetic induction would have had potential risks of airway obstruction. Thus, after placing the patient in the semi-left decubutus position, we chose semi-awake induction to secure the airway. With a small dose of fentanyl, we accomplished orotracheal intubation. In this report, we discuss the importance of referring to an airway management algorithm when encountering a difficult airway.

When can we give general anesthesia to an infant with anticipated difficult airway management caused by facial vascular malformation?

“…Few case reports exist that describe airway management for surgical resection of facial hemangioma in children [2, 3]. Although they can have rapid progression and spontaneous involution in 90% of cases, vascular malformation usually shows slow progression, without spontaneous regression [4].…”

Anticipated Difficult Airway in Ear, Nose and Throat Procedures

“…radiography, computed tomography scans, fluoroscopy) can identify a variety of acquired or congenital features in patients with difficult airways. [25][26][27] In patients presenting for elective and emergency ENT surgery, in whom a difficult airway is anticipated, history of previous radiotherapy, the presence of airway symptoms, a reduced mouth opening and a reduced mandibular protrusion are independent predictors of a difficult intubation. 28 Predictors of difficult face mask ventilation are: 29…”