Pre-anesthetic evaluation can play a crucial role in the determination of airway management in a child with oropharyngeal tumor

• Published in: Journal of anesthesia Vol. 20; no. 3; pp. 215 - 219
• Main Authors: Aoi, Yoshihiro, Kamiya, Yoshinori, Shioda, Masashi, Furuya, Ryosuke, Yamada, Yoshitsugu
• Format: Journal Article
• Language: English
• Published: Japan Springer 20-08-2006
• Subjects: Airway Obstruction - prevention & control; Anesthetics, Intravenous - therapeutic use; Anti-Arrhythmia Agents - administration & dosage; Anti-Inflammatory Agents - administration & dosage; Anti-Ulcer Agents - administration & dosage; Atropine - administration & dosage; Care and treatment; Child; Diagnosis; Female; Fentanyl - therapeutic use; Fiber Optic Technology - methods; Hemangioma - diagnosis; Hemangioma - surgery; Humans; Hydrocortisone - administration & dosage; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - methods; Laryngoscopy - methods; Oropharyngeal Neoplasms - diagnosis; Oropharyngeal Neoplasms - surgery; Oropharynx - diagnostic imaging; Oropharynx - surgery; Posture - physiology; Preoperative care; Preoperative Care - methods; Ranitidine - administration & dosage; Rare Diseases; Throat cancer; Tomography, X-Ray Computed - methods; Tracheotomy; United States
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-006-0392-y

We experienced a case of a huge hemangioma occupying the oropharyngeal space in an 11-year-old child. Although urgent surgical tracheostomy under local anesthesia was suggested initially, medical interview and findings of computerized tomography and fiberoptic laryngoscopy revealed that the airway of the patient was relatively stable when she was in the semi-left decubitus position. General anesthetic induction would have had potential risks of airway obstruction. Thus, after placing the patient in the semi-left decubutus position, we chose semi-awake induction to secure the airway. With a small dose of fentanyl, we accomplished orotracheal intubation. In this report, we discuss the importance of referring to an airway management algorithm when encountering a difficult airway.