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[Anesthesia Management for Primary Cleft Lip Closure in an Infant with Congenital Total Length Complete Tracheal

Junichi Yoshinaga, Noriko Miyazawa, Atsushi Hanzawa

    Masui. the Japanese Journal of Anesthesiology
    |October 7, 2015
    PubMed

    Insights

    Congenital tracheal stenosis due to complete tracheal rings poses surgical risks. This case report details successful cleft lip repair in an infant using a narrow endotracheal tube, avoiding tracheal injury.

    Area of Science:

    • Pediatric Surgery
    • Anesthesiology
    • Medical Imaging

    Background:

    • Congenital tracheal stenosis, often caused by complete tracheal rings, presents significant challenges in neonates and infants.
    • Perioperative management is critical to prevent further tracheal stenosis in these vulnerable patients.

    Observation:

    • An 8-month-old infant with a history of failed intubation due to complete tracheal rings was scheduled for cleft lip repair.
    • Imaging revealed long-segment tracheal stenosis below the glottis, with complete rings identified via endoscopy.
    • An aspiration episode prompted prompt surgical intervention.

    Findings:

    • Successful primary cleft lip closure was achieved under general anesthesia using a narrow (3.0 mm ID) RAE endotracheal tube.
    • Endoscopic confirmation ensured the tube's tip avoided contact with the stenotic segment.
    • The infant was discharged on postoperative day 8 without complications.

    Implications:

    • This case highlights the importance of detailed preoperative imaging and endoscopic evaluation for managing congenital tracheal stenosis.
    • Careful selection of endotracheal tube size and precise placement are crucial for safe surgical procedures in affected infants.
    • Successful surgical outcomes are achievable with meticulous planning and execution in complex pediatric cases.

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