Airway management for glossopexy in infants with micrognathia and obstructive breathing

• Published in: Journal of clinical anesthesia 2017-02, Vol.36, p.127-132
• Main Authors: Morimoto, Yoshinari, DDS, PhD, Ohyamaguchi, Aiko, DDS, PhD, Inoue, Mika, DDS, PhD, Yokoe, Chizuko, DDS, PhD, Hanamoto, Hiroshi, DDS, PhD, Imaizumi, Uno, DDS, PhD, Sugimura, Mitsutaka, DDS, PhD, Niwa, Hitoshi, DDS, PhD
• Format: Article
• Language: English
• Subjects: Airway management; Airway Management - methods; Airway Obstruction - surgery; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, General - methods; Craniofacial Abnormalities - surgery; Difficult airway; Endoscopy; Female; Fiber Optic Technology - methods; Fiberscope; Glossopexy; Humans; Infant; Intubation; Intubation, Intratracheal - methods; Laryngoscopy - methods; Lip - surgery; Male; Micrognathism - surgery; Nasotracheal intubation; Ostomy; Pain Medicine; Patients; Pierre Robin Syndrome - surgery; Reoperation - methods; Retrospective Studies; Surgery; Tongue - surgery; Video laryngoscope
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.10.019

Abstract Study objectives To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia. Design Retrospective, observational study. Settings Operating room of a university hospital between January 2003 and March 2015. All operations were performed by oral and maxillofacial surgeons. Patients Thirteen patients who received general anesthesia for glossopexy and reversal after 7 months. Measurements The medical records of these infants were retrospectively examined to evaluate the following: age, sex, height and weight at surgery, preoperative airway status, tracheal intubation route (oral or nasal), method for inducing general anesthesia, method for establishing the airway during mask ventilation, apparatus used for tracheal intubation, Cormack-Lehane classification when using a Macintosh laryngoscope and video laryngoscope, and the need for airway placement after extubation. Results Prone positioning and/or an airway of some kind before surgery were required in 38.5% of infants needing glossopexy. Difficult mask ventilation was common, occurring in 50% of the patients, and the incidence of airway placement during mask ventilation was significantly higher in infants with preoperative complete or incomplete obstruction (100%) than in infants with snoring (25%). Of these high-risk infants, 25% could not be intubated with a direct laryngoscope or Glidescope Cobalt and required fiberoptic intubation. Conclusion There are severe cases of infants with difficult mask ventilation and difficult tracheal intubation in which a fiberscope is required because video laryngoscopy fails to improve the view of the larynx.