Frontoethmoidal encephalocele: a pediatric airway challenge

Excerpt

A three-month-old male infant with a history of frontoethmoidal encephalocele presented for surgical repair of the lesion. Because of the anatomical location of the encephalocele, difficult mask ventilation was anticipated. Accordingly, meticulous care was taken to ensure adequate seal with a Carefusion infant size 2 face mask (Carefusion Corporation, San Diego, CA, USA) placed over the mouth, just below the lesion, while compressing the nasal alae prior to anesthesia induction. Anesthesia was induced by inhalation of 100% O₂ plus sevoflurane 8%, followed by establishment of intravenous access. Adequate ventilation was confirmed through mask ventilation and again after a size 1 Ambu supraglottic airway (Ambu, Ballerup, Denmark) was inserted. After testing the ability to ventilate the patient with moderate positive pressure via the supraglottic airway, neuromuscular blockade was administered. We proceeded to complete a full airway evaluation. The supraglottic airway was removed, and direct laryngoscopy revealed a grade 2b view. An air-Q™ (Mercury Medical, Clearwater, FL, USA) supraglottic airway1 size 1 was inserted, and easy ventilation was again confirmed. A 3.0 cuffed endotracheal tube subsequently easily passed through the supraglottic airway without the use of flexible bronchoscopy to assist in its passage. Placement was confirmed by capnography. Oxygen desaturation did not occur during airway evaluation or intubation. The patient remained intubated at the end of the procedure and was extubated on postoperative day 2. …