Anterior neck haematoma is a rare but potentially fatal emergency due to airway obstruction after a surgical intervention of the neck. Complete airway obstruction can be rapid and deteriorate exponentially. In a patient with a previously normal laryngeal view during his Sistrunk procedure, we describe the challenges and considerations faced in his second surgery for the evacuation of neck haematoma, which involved an unanticipated difficult airway after rapid sequence induction, necessitating rescue measures using low-skill fibreoptic intubation (LSFOI).

Acromegaly is a rare endocrine disorder characterized by excessive growth hormone (GH) secretion, usually due to a pituitary adenoma. This condition leads to progressive somatic disfigurement, including enlarged hands, feet, and facial features, and is often associated with systemic complications such as cardiovascular disease, diabetes mellitus, and sleep apnea. Anesthesia for patients with acromegaly presents unique challenges due to the characteristic anatomical and physiological changes associated with the condition. Acromegaly, resulting from excessive GH secretion, often leads to difficult airway management, cardiovascular complications, and metabolic abnormalities. Transnasal transsphenoidal excision of pituitary adenoma is a minimally invasive surgical technique employed to remove pituitary tumors. This approach, which utilizes the nasal passages and sphenoid sinus to access the pituitary gland, offers several advantages, including reduced recovery time, minimal scarring, and lower risk of complications compared to traditional craniotomy. Awake fiberoptic intubation is one of the recommended strategies to secure an expected difficult airway such as in acromegaly. This case highlights the importance of preoperative planning and the role of an oral fiberoptic technique in managing the airway in surgeries like the transnasal approach.

UNASSIGNED: Difficult airway management is one of the main challenges in paediatric anaesthesia, particularly in low- and middle-income countries.
UNASSIGNED: The aim of this study was to investigate the main predictors of difficult paediatric intubation.
UNASSIGNED: In this observational study, we included all children aged less than five years undergoing intra-abdominal surgery with endotracheal intubation. Patients were divided into two groups according to the incidence of difficult intubation. Then, we investigated predictors for difficult paediatric intubation.
UNASSIGNED: We included 217 children, and difficult intubation was observed in 10% of them. Predictors were as follows: Mallampati III-IV class (adjusted odds ratio = 2.21; 95% confidence interval = 1.1-6.4), limited mouth opening (adjusted odds ratio = 2.4; 95% confidence interval = 1.8-3.5), facial dysmorphia (adjusted odds ratio = 2.6; 95% confidence interval = 1.32-7.4) and anaesthesia without muscle relaxant (adjusted odds ratio = 1.8; 95% confidence interval = 1.0-5.1) or without opioids during crash inductions (adjusted odds ratio = 1.7; 95% confidence interval = 1.01-4.8).
UNASSIGNED: Facial dysmorphia and limited mouth opening were predictors of difficult intubation in children. Furthermore, it seems that Mallampati class and anaesthesia technique may also predict challenging intubation, which may guide us to change our perioperative practice.

Total laryngectomy is the gold standard surgical approach for laryngeal cancer and is generally conducted under general anesthesia. Orotracheal intubation remains a very delicate step in the general anesthesia process. In otolaryngology (ENT) surgery, it remains considered the preferred method of anesthesia for many surgical procedures. A significant challenge in oncological ENT surgery is the difficulty associated with orotracheal intubation, due to a number of reasons that can lead to failure of orotracheal intubation. To mitigate this risk, experts recommend proceeding with orotracheal intubation with the patient awake and breathing spontaneously. In this case series, we report four patients with supraglottic tumors of the larynx who underwent total laryngectomy surgery under general anesthesia, during which they underwent orotracheal intubation while awake and spontaneous breathing, under no sedative drugs of any kind, in order to avoid complications of orotracheal intubation failure and respiratory apnea due to bleeding tumor masses that engaged the supraglottic space.

The aim of this study was to assess the usefulness of an attachable video laryngoscope (AVL) by attaching a camera and a monitor to a conventional Macintosh laryngoscope (CML). Normal and tongue edema airway scenarios were simulated using a manikin. Twenty physicians performed tracheal intubations using CML, AVL, Pentax Airwayscope® (AWS), and McGrath MAC® (MAC) in each scenario. Ten physicians who had clinical experience in using tracheal intubation were designated as the skilled group, and another ten physicians who were affiliated with other departments and had little clinical experience using tracheal intubation were designated as the unskilled group. The time required for intubation and the success rate were recorded. The degree of difficulty of use and glottic view assessment were scored by participants. All 20 participants successfully completed the study. There was no difference in tracheal intubation success rate and intubation time in the normal airway scenario in both skilled and unskilled groups. In the experienced group, AWS had the highest success rate (100%) in the tongue edema airway scenario, followed by AVL (60%), MAC (60%), and CML (10%) (p = 0.001). The time required to intubate using AWS was significantly shorter than that with AVL (10.2 s vs. 19.2 s) or MAC (10.2 s vs. 20.4 s, p = 0.007). The difficulty of using AVL was significantly lower than that of CML (7.8 vs. 2.8; p < 0.001). For the experienced group, AVL was interpreted as being inferior to AWS but better than MAC. Similarly, in the unskilled group, AVL had a similar success rate and tracheal intubation time as MAC in the tongue edema scenario, but this was not statistically significant. The difficulty of using AVL was significantly lower than that of CML (8.8 vs. 3.3; p < 0.001). AVL may be an alternative for VL.

Temporomandibular joint (TMJ) ankylosis is generally characterised by a complex aetiology, with several contributing causes, including infections, autoimmune diseases, trauma, and congenital anomalies. This case report describes a three-year-old female suffering from traumatic temporomandibular ankylosis with retrognathia, severe mouth-opening restriction, and obstructive sleep apnea (OSA). The present case highlights the difficulties with TMJ ankylosis, especially when access to healthcare is sought out late and delayed diagnosis is prevalent. Mandibular distraction osteogenesis and awake fiberoptic intubation were used in the surgical and anaesthetic management of this case, with the otorhinolaryngology team on standby to perform a tracheostomy if required, highlighting the necessity of a multidisciplinary approach in such cases. Patients with TMJ ankylosis have significant life-altering changes, including psychological stress, chewing difficulty, speech difficulties, facial distortion, and speech impediment. When OSA progresses, it also presents more health risks. For the purpose of treating TMJ ankylosis, avoiding serious problems, and enhancing patient well-being, prompt diagnosis and therapy are crucial. In order to optimise patient results, this case study highlights the need for knowledge and research in the treatment of TMJ ankylosis as well as the requirement of medical professionals working together in a synergistic way.

暂无摘要。

We report a case of a cannulated nasopharyngeal airway (NPA) in a patient having a neurological deficit, absent gag reflex, and no clinically obvious signs of respiratory distress. The patient had two episodes of vomiting before admission and was admitted with the initial working diagnosis of aspiration pneumonia; however, a preliminary chest X-ray (CXR) revealed an NPA, sitting vertically in the airway. It is our emphasis that thorough clinical history and radiological imaging are of paramount importance in prompt management of such airway complications.

Morquio syndrome is a subtype of mucopolysaccharidoses, wherein the accumulation of glycosaminoglycans (GAGs) in various organ systems lead to alteration of anatomy and physiology. Most prominent features are extensive bony abnormalities, which normally require surgical correction. This paper reports the case of a 7-year-old child with Morquio syndrome who successfully underwent correction of genu valgum under general endotracheal anesthesia via asleep induction and videolaryngoscopy, with supplemental peripheral nerve block. The precautions and anesthetic care done to ensure a safe procedure are discussed, especially with anticipation of a possible difficult airway.

Temporomandibular joint (TMJ) ankylosis is a form of TMJ condition that causes mouth opening limitation, ranging from partial reduction to total immobilization of the jaw. Bony and fibrous ankylosis is most commonly caused by trauma, although it can also happen as a result of surgery, local or systemic infections, or systemic diseases. Childhood TMJ produces facial deformities, which increase with growth and have a major detrimental impact on the patient\'s psychological development. Each patient with TMJ ankylosis must have a history, physical examination, and radiographic examination in order to determine a definitive diagnosis, severity, involvement of surrounding tissues, and, ultimately, treatment planning. Technical challenges and a high recurrence rate make treating TMJ ankylosis challenging. Intubating a young child with TMJ ankylosis is a difficult job, which is exacerbated by limited mouth opening. This case report describes a five-year-old boy who reported an inability to open his mouth, diagnosed as TMJ ankylosis, and managed in the absence of an appropriately sized tracheostomy tube.