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Awake videolaryngoscopy in a child with a predicted difficult airway due to a large craniofacial vascular tumour

Awake videolaryngoscopy in a child with a predicted difficult airway due to a large craniofacial... A 13‐year‐old, 28 kg, short‐statured (127 cm) male presented with a history of headache and progressive facial swelling associated with bilateral proptosis, visual loss, palatal distortion and episodic profuse nasal bleeding (Fig. 1a and b). Magnetic resonance imaging (MRI) revealed a large irregular lesion (7.5 cm × 9.5 cm × 11 cm) in the frontal lobes, extending into the ethmoid and sphenoid sinuses, nasopharynx, left orbit and optic chiasma (Fig. 1e). An endoscopic biopsy of the mass was planned. Given the anticipated difficulty with bag‐mask ventilation and nasopharyngeal patency, awake videolaryngoscopy with orotracheal intubation was planned.1FigureFront (a) and side (b) profile of the patient; glottic view on C‐MAC® (c) and (d); and a representative magnetic resonance imaging slice demonstrating the mass (e).Topical anaesthesia of the patient's airway was achieved with 4 ml of lidocaine 4% gargle and 3 puffs of lidocaine 10% spray, supplemented with a bilateral superior laryngeal nerve block with 2 ml of lidocaine 2%. A dexmedetomidine infusion (0.5 μg.kg−1) was given over 10 min for anxiolysis. Laryngoscopy was performed using a C‐MAC® videolaryngoscope (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) with a size 3 blade, with lidocaine 2% jelly applied to the dorsal aspect. A percentage of glottic opening (POGO) score of 0 was obtained (only the epiglottis could http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Awake videolaryngoscopy in a child with a predicted difficult airway due to a large craniofacial vascular tumour

Gupta, A.; Singh, M.; Munda, A.; Gupta, N.
Anaesthesia Reports , Volume 10 (2) – Jul 1, 2022
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Publisher
Wiley
Copyright
2022 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12202
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Abstract

A 13‐year‐old, 28 kg, short‐statured (127 cm) male presented with a history of headache and progressive facial swelling associated with bilateral proptosis, visual loss, palatal distortion and episodic profuse nasal bleeding (Fig. 1a and b). Magnetic resonance imaging (MRI) revealed a large irregular lesion (7.5 cm × 9.5 cm × 11 cm) in the frontal lobes, extending into the ethmoid and sphenoid sinuses, nasopharynx, left orbit and optic chiasma (Fig. 1e). An endoscopic biopsy of the mass was planned. Given the anticipated difficulty with bag‐mask ventilation and nasopharyngeal patency, awake videolaryngoscopy with orotracheal intubation was planned.1FigureFront (a) and side (b) profile of the patient; glottic view on C‐MAC® (c) and (d); and a representative magnetic resonance imaging slice demonstrating the mass (e).Topical anaesthesia of the patient's airway was achieved with 4 ml of lidocaine 4% gargle and 3 puffs of lidocaine 10% spray, supplemented with a bilateral superior laryngeal nerve block with 2 ml of lidocaine 2%. A dexmedetomidine infusion (0.5 μg.kg−1) was given over 10 min for anxiolysis. Laryngoscopy was performed using a C‐MAC® videolaryngoscope (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) with a size 3 blade, with lidocaine 2% jelly applied to the dorsal aspect. A percentage of glottic opening (POGO) score of 0 was obtained (only the epiglottis could

Journal

Anaesthesia Reports – Wiley

Published: Jul 1, 2022

Keywords: awake intubation; awake videolaryngoscopy; difficult airway; paediatric

References

  • The emerging role of awake videolaryngoscopy in airway management
    Wilson, WM; Smith, AF
  • Videolaryngoscopy versus fiberoptic bronchoscope for awake intubation–a systematic review and meta‐analysis of randomized controlled trials
    Jiang, J; Ma, DX; Li, B; Wu, AS; Xue, FS