Difficult airway management – an old challenge: a case report

Abstract

Introduction: Obtaining a secured airway is a vital aspect during reconstructive surgery in patients with extensive post-burn mentosternalscar contractures. Such contractures can potentially lead to a “can’t intubate, can’t ventilate” scenario, otherwise rare butlife-threatening situation. We present a case of successful management of a paediatric case of anticipated difficult airway due toburn injury.Case description: A 14-year-old boy presented for repair of an extensive skin contracture of the neck, thorax and face due to mutilatingscarring. The boy was treated for 80% burn caused by gasoline flame 14 months prior to this surgery. Burn healing and scarringresulted 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 visualisationof 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 firstattempt. Balanced general anaesthesia was initiated and planned surgical procedure was successfully completed. The trachea wasextubated 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 significantrisks and complications. Anticipating a difficult airway, having a structured approach with appropriate preparation, andunderstanding of difficult airway management algorithms are essential for success.Key words: airway management; burns; intubation