Bhardwaj Ajit, Grewal Ritu, Trivedi Shaleen, Singh Shivinder
Dept Of Anaesthesia, & Critical Care, Command Hospital Lucknow, India.
Oxf Med Case Reports. 2022 Dec 23;2022(12):omac132. doi: 10.1093/omcr/omac132. eCollection 2022 Dec.
Pierre Robin syndrome (PRS) neonates are one of the most difficult cases to intubate even for an experienced paediatric anaesthesiologist. We describe a case of a PRS-related anatomical anomaly that hindered attempts to manage the airway and the final approach that made it possible to insert an endotracheal tube (ETT). We describe the novel use of a video ureteroscope (Olympus URF-V2) as an airway endoscope. A 7-day-old, 2-kg boy was referred to our tertiary care hospital with diagnosed PRS. He was planned for correction of the mandible with mandibular distraction osteogenesis under general anaesthesia. Fibreoptic scope (Olympus, Japan) revealed the epiglottis lying on the posterior pharynx, which could not be manoeuvred. Due to repeated attempts, the patient developed laryngospasm, and his pulse arterial oxygen saturation (SpO2) was reduced to 70%. Following jaw thrust and slight pulling of the tongue with Magill's Forceps, a 150-cm long and 0.035-inch diameter atraumatic, Roadrunner® hydrophilic polyurethane-coated guidewire was introduced through the working channel of the video ureteroscope into the trachea under the vision (and a 3.5-mm ID ETT was railroaded over it and a definitive airway was established). A flexible fibreoptic ureteroscope may be useful in the management of a difficult airway and may become an important tool in the armoury of an anaesthesiologist. At our institute, which is a tertiary care centre, we are now training and utilising video-ureteroscope as an airway endoscope. To our knowledge, there is no documentary evidence of the use of a video ureteroscope for difficult airway management of a neonate.
皮埃尔·罗宾综合征（PRS）新生儿即使对于经验丰富的儿科麻醉医生来说，也是最难插管的病例之一。我们描述了一例与PRS相关的解剖异常病例，该异常阻碍了气道管理尝试以及最终成功插入气管内导管（ETT）的方法。我们描述了将视频输尿管镜（奥林巴斯URF-V2）作为气道内镜的新用途。一名7天大、体重2千克的男婴因诊断为PRS被转诊至我们的三级护理医院。计划在全身麻醉下通过下颌骨牵张成骨术矫正下颌骨。纤维喉镜（日本奥林巴斯）显示会厌位于下咽，无法移动。由于多次尝试，患者发生喉痉挛，其脉搏血氧饱和度（SpO2）降至70%。在进行下颌前推并用麦吉尔钳轻轻牵拉舌头后，将一根150厘米长、直径0.035英寸的无创伤、路行者®亲水聚氨酯涂层导丝通过视频输尿管镜的工作通道在直视下插入气管（然后将一根内径3.5毫米的ETT沿导丝推送，建立了确定性气道）。柔性纤维输尿管镜可能有助于困难气道的管理，可能成为麻醉医生的重要工具。在我们作为三级护理中心的机构，我们现在正在培训并将视频输尿管镜用作气道内镜。据我们所知，尚无使用视频输尿管镜进行新生儿困难气道管理的文献证据。
