Varghese Merin, Muniyappa Reshma B, Harsoor S S, Madhuri Gangisetty Sri
Department of Anesthesiology, Dr B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India.
Saudi J Anaesth. 2024 Jul-Sep;18(3):447-449. doi: 10.4103/sja.sja_29_24. Epub 2024 Jun 4.
Restricted mouth opening is a challenging airway in pediatric patients with temperomandibular joint (TMJ) ankylosis. The fiber-optic bronchoscopic nasotracheal intubation technique continues to be the gold standard for difficult airway, among the techniques available such as submandibular intubation, retrograde intubation, and tracheostomy. However, awake fiber-optic bronchoscopy (FOB) is difficult to achieve in pediatric patients. Prior planning of the anesthetic method and effective collaboration with the surgeon are crucial for excellent outcomes in such challenging airway cases. We present a successful awake fiber-optic bronchoscopy with high-flow nasal oxygen (HFNO), airway blocks, and deep sedation in the case of bilateral TMJ ankylosis of a pediatric age group with reduced mouth opening. We conclude that awake intubation using HFNO and airway blocks helps to achieve oxygenation and ease of intubation in difficult airway management.
张口受限是颞下颌关节（TMJ）强直的儿科患者面临的具有挑战性的气道问题。在诸如下颌下插管、逆行插管和气管切开术等可用技术中，纤维支气管镜经鼻气管插管技术仍然是困难气道的金标准。然而，清醒纤维支气管镜检查（FOB）在儿科患者中很难实现。对于此类具有挑战性的气道病例，预先规划麻醉方法并与外科医生进行有效协作对于取得良好结果至关重要。我们报告了一例在儿科年龄组双侧TMJ强直且张口减少的病例中，成功实施了使用高流量鼻氧（HFNO）、气道阻滞和深度镇静的清醒纤维支气管镜检查。我们得出结论，在困难气道管理中，使用HFNO和气道阻滞进行清醒插管有助于实现氧合并便于插管。
