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         CASE REPORT: AWAKE NASAL INTUBATION WITH THE USE OF VIDEO-LARYNGOSCOPE, IN A PATIENT WITH A BACKGROUND OF TREACHER COLLINS SYNDROME, PRESENTING FOR THYROGLOSSAL DUCT CYST EXCISION
Eleftheria Saoulidou1, Theodora Aggeli1, Dimitrios Katsaros1, Marina Makrypodi1, Amalia Douma1, Antonia Dimakopoulou1
1 Anesthesiology Department, General Hospital of Athens “G. Gennimatas”
    Aim Of Study: Treacher Collins Syndrome (TCS) is a rare congenital disorder with mandibulofacial dysostosis. The craniofacial development is characterized by maxillary, zygomatic and mandibular dysplasia. Anesthetic management of patients with TCS is very challenging, particularly with regards to airway management due to smaller oropharynx, limited mouth opening, mandibular hypoplasia and hypo plastic larynx. We present the case of an awake nasal intubation, using the video-laryngoscope, as a method of choice to manage the craniofacial deformities, in a patient with AS, presenting electively for a thyroglossal duct cyst excision.
Case Report: A 41-year-old male, with a past medical history of TCS presented for a thyroglossal duct cyst excision. Pre-operative airway assessment revealed no flexion, extension or jaw protrusion, with minimal mobility of the cervical and thoracolumbar spine (Mallampati IV). Mouth opening was less than 3cm and thyro-mental and sterno-mental distances were reduced. Routine pre-operative blood tests and ECG were found to be normal. Anaesthetic planning included the patient being in supine position, with his head and neck supported by pillows. Preoxygenation with 100% O2 was administered for 3 min. Pulse oximetry, non-invasive blood pressure monitoring and double peripheral venous access were applied and sedation was achieved with a bolus of Dexmetomidine (1mcg/kg) over 10min followed by a continuous infusion of 0.4 μg/kg/h and Remifentanyl (2ng/ml)-TCI. Lidocaine 10% spray was used for local airway anesthesia (8mg/kg). Video-laryngoscopy (c-mac, d-blade) was performed and nasotracheal intubation with a No-6.5 cuffed tube was successfully achieved. The surgery completed uneventfully and extubation was successful.
Conclusions: Most patients with TCS have difficult laryngoscopic views, with many requiring specialized intubation techniques. By presenting this case, it is intended to show that planning, communication and teamwork are indispensable for patient safety.
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