Paediatria Croatica, Vol. 63 No. 1, 2019.
Recenzija, Prikaz slučaja
https://doi.org/10.13112/PC.2019.7
Difficult airway management – an old challenge: a case report
Ksenija Črnjar
Sandra Kralik
Ivana Kerovec Sorić
Ivan Bekavac
Zoran Barčot
Diana Butković
Sažetak
Introduction: Obtaining a secured airway is a vital aspect during reconstructive surgery in patients with extensive post-burn mentosternal
scar contractures. Such contractures can potentially lead to a “can’t intubate, can’t ventilate” scenario, otherwise rare but
life-threatening situation. We present a case of successful management of a paediatric case of anticipated difficult airway due to
burn injury.
Case description: A 14-year-old boy presented for repair of an extensive skin contracture of the neck, thorax and face due to mutilating
scarring. The boy was treated for 80% burn caused by gasoline flame 14 months prior to this surgery. Burn healing and scarring
resulted in massive distortion of the facial and cervical anatomy, all implying difficult airway with a high probability of “can’t intubate,
can’t ventilate” situation. Flexible fiberoptic bronchoscope with loaded cuffed endotracheal tube N° 6.0 was used for visualisation
of vocal cords through the mouth in light sedation with spontaneous breathing. After visualisation of the vocal cords, fentanyl
(Fentanyl, GlaxoSmithKline) and thiopental (Thiopental, Rotexmedica) were administered and the trachea was intubated at the first
attempt. Balanced general anaesthesia was initiated and planned surgical procedure was successfully completed. The trachea was
extubated on the first postoperative day without any complication.
Conclusion: Difficult paediatric airway and particularly “can’t intubate, can’t ventilate” situation is a problem associated with significant
risks and complications. Anticipating a difficult airway, having a structured approach with appropriate preparation, and
understanding of difficult airway management algorithms are essential for success.
Ključne riječi
airway management; burns; intubation
Hrčak ID:
220746
URI
Datum izdavanja:
23.5.2019.
Posjeta: 1.732 *