Anesthesia in a patient with moebius sequence: case report

Moebius sequence (MS) is a rare paralysis of the VI and VII cranial nerves. Craniofacial changes, which can hinder tracheal intubation considerably, are seen in approximately 90% of the patients.

A male patient, 2 years and 5 months old, with MS, underwent flexible bronchoscopy for evaluation of laryngotracheomalacia. Comorbidities: bronchospasm and interventricular communication. Anesthesia was induced with sevoflurane in 100% O2, followed by venoclysis. A number 2.5 laryngeal AMBU mask was inserted and the fiberbronchoscope scope introduced through the mask. The procedure evolved without complications and bronchoscopy was normal. The patient was discharged home after two hours.

Airways management is a great challenge in those patients with a report of failure or difficult intubation in 13 out of 41 patients. Micrognathia, retrognathia, mandibular hypoplasia, and palatine cleft are some of the manifestations seen in those patients. The use of a laryngeal mask was reported in one patient in a large series with 106 anesthesias in patients with MS. There does not seem to be contraindications to perform the procedure in an outpatient setting. Pulmonary aspiration and respiratory obstruction in the recovery room due to difficulty swallowing and eliminating mouth secretions have been reported, and the use of anti-sialagogues recommended.