Anaesthesiology, All India Institute of Medical Sciences - Patna, Patna, Bihar, India
Anaesthesiology, All India Institute of Medical Sciences - Patna, Patna, Bihar, India.
BMJ Case Rep. 2024 Aug 29;17(8):e260612. doi: 10.1136/bcr-2024-260612.
The association of Robin sequence (RS) with temporomandibular joint (TMJ) ankylosis is not a common occurrence. Due to restricted mouth opening, difficult bag valve mask ventilation and difficult intubation, such cases are always challenging for anaesthesiologists.A male patient in early childhood with RS and bilateral TMJ ankylosis was scheduled for bilateral gap arthroplasty. Airway management was planned with fibreoptic intubation under sedation to preserve spontaneous ventilation. After sedating the patient, a nasopharyngeal airway modified by using an endotracheal tube connector was inserted in the left nostril and connected to the ventilator circuit with a 15 mm universal connector. Pressure support ventilation was given with continuous end-tidal CO monitoring. Fibreoptic intubation was done through the right nostril with maintenance of spontaneous ventilation.Nasal pressure support ventilation assembly can be made with available equipment in the operation theatre. It can be a substitute for a high-flow nasal cannula in particular cases.
Robin 序列（RS）与颞下颌关节（TMJ）强直的关联并不常见。由于张口受限，难以进行球囊面罩通气和插管，这些情况对麻醉师来说总是具有挑战性。一名患有 RS 和双侧 TMJ 强直的幼儿男性患者被安排进行双侧间隙成形术。计划在镇静下进行纤维光导插管进行气道管理，以保留自主通气。在给患者镇静后，将使用气管内插管连接器改装的鼻咽气道插入左鼻孔，并使用 15 毫米通用连接器与呼吸机回路连接。给予压力支持通气，并连续进行呼气末 CO 监测。通过右鼻孔进行纤维光导插管，并维持自主通气。可以使用手术室中的现有设备制作鼻内压力支持通气组件。在特殊情况下，它可以替代高流量鼻导管。
