Lucín Yagual Teresa Anabel, Vivanco Murillo Sócrates Marcelo, Espinoza Daquilema Nataly Vanessa, Mariscal García Raisa Stefanía, Dick Paredes Daniel Fernando
Anesthesiology and Reanimation, Hospital General Guasmo Sur, Guayaquil, ECU.
Oral and Maxillofacial Surgery, Hospital General Guasmo Sur, Guayaquil, ECU.
Cureus. 2021 Apr 24;13(4):e14659. doi: 10.7759/cureus.14659.
The anesthetic approach to patients with facial deformities, such as midface hypoplasia (MFH), is complex and requires coordinated work with the surgical team. These patients may have a difficult airway (DA), and hence special considerations must be taken from the anesthetic point of view, and several options have been described by the American Society of Anesthesiology (ASA) related to this. Multiple methods have been described for intubation and maintenance; for extubation in pediatric patients, there are no defined guidelines. Extubation can be performed under deep anesthesia or with the patient awake, taking special considerations by keeping their condition in mind; these approaches have shown varying results. Favorable outcomes have been observed in the literature and personal experiences with smooth extubation techniques in patients at a high risk of reintubation, such as those with dentofacial deformities and the pediatric population. A 15-year-old girl with a diagnosis of severe malar hypoplasia associated with a cleft lip (CL) was admitted to our hospital. She had a history of previous surgeries and had persistent functional disorders, for which surgical placement of facial distractors was scheduled. For the anesthetic approach, a balanced general anesthesia option was chosen. The use of a video laryngoscope was determined to be the proper choice for DA, with the fixation of the oral endotracheal tube (OETT) in a caudal direction, and with mechanical-ventilator settings appropriate for the patient's age. Deep extubation with smooth extubation techniques was performed successfully. No anesthetic complications were observed in this case.
对于面部畸形患者，如面中部发育不全（MFH），麻醉方法复杂，需要与手术团队协同工作。这些患者可能存在困难气道（DA），因此必须从麻醉角度进行特殊考虑，美国麻醉医师协会（ASA）已描述了与此相关的几种选择。已经描述了多种插管和维持方法；对于儿科患者的拔管，尚无明确指南。拔管可在深度麻醉下或患者清醒时进行，要牢记其病情并给予特殊考虑；这些方法的效果各不相同。在文献和个人经验中，对于有再插管高风险的患者，如牙颌面畸形患者和儿科人群，采用平稳拔管技术已观察到良好结果。一名诊断为严重颧骨发育不全合并唇裂（CL）的15岁女孩入住我院。她有既往手术史且存在持续的功能障碍，计划对面部进行牵张器手术植入。对于麻醉方法，选择了平衡全身麻醉方案。确定使用视频喉镜处理困难气道，将口腔气管导管（OETT）向尾端固定，并根据患者年龄设置合适的机械通气参数。采用平稳拔管技术成功进行了深度拔管。该病例未观察到麻醉并发症。
