Airway management under general anesthesia for infants and young children with the first and second branchial syndrome featuring unilateral mandibular dysplasia: A case series of 8 children

Abstract

ObjectiveTo investigate and summarize the airway management methods for infants and young children of the first and second branchial syndrome featuring mandibular dysplasia, and to evaluate the auxiliary effect of direct laryngoscope and video laryngoscope during tracheal intubation. MethodsFrom March 2017 to March 2022, 8 cases with the first and second branchial syndrome featuring absent or hypoplastic mandibular ascending ramus that underwent cleft palate repair or transverse facial cleft repair under general anesthesia were retrospectively reviewed and summarized. The information such as demographic data, preoperative airway assessment, mask ventilation effect, anesthesia method, anesthesiologist's evaluation of laryngoscope exposure and intubation, operation method, operation time, and extubation time was collected. ResultsThe median age of the 8 children was 12 months; none of them had limitation of mouth opening, 4 had snoring during sleep, 2 had unilateral absence of the ascending ramus of the mandible, and 6 had partial absence. Of the 8 children, 3 underwent cleft palate repair, and 5 underwent transverse facial cleft repair. During anesthesia induction, 1 case of mask ventilation was graded as Grade 2, and the other 7 cases were graded as Grade 1; the Cormack-Lehane (C-L) grade of glottic exposure by direct laryngoscope was graded as Grade 3 (3 cases) and Grade 4 (5 cases), and the C-L grade by video laryngoscope was graded as Grade 1 (4 cases) and Grade 2 (4 cases). All the children completed video laryngoscope-assisted intubation successfully in one time. The extubation was completed smoothly, without complications related to anesthesia. The median operation time was 50 minutes, and the median time from end of operation to extubation was 240 seconds. ConclusionFor anesthesia of infants and children with the first and second branchial syndrome, especially those with hypoplasia of the mandible, a comprehensive preoperative assessment is needed, and direct laryngoscope may lead to difficulty in glottic exposure, and adequate planning for difficult airway management is necessary.