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Anesthetic management of vallecular cyst excision in an infant: An airway challenge
Viraj N Namshikar1, Nimisha V Dukle1, Dattraj S Sukhthanker1
1Department of Anaesthesiology, Goa Medical College, Goa, India.
Insights
Anesthetic management for vallecular cysts in infants requires careful planning. This case highlights challenges in airway management and the importance of maintaining spontaneous respiration during surgery for this rare cause of upper airway obstruction.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Otolaryngology
Background:
- Vallecular cysts are rare congenital anomalies causing upper airway obstruction in infants.
- Prompt diagnosis and surgical intervention are crucial for managing respiratory distress.
Observation:
- A 4-month-old infant presented with progressive inspiratory stridor due to a large vallecular cyst.
- Anesthetic management focused on inhalational induction, maintaining spontaneous respiration, and preparing for difficult intubation.
Findings:
- Laryngoscopy was challenging due to cyst size, requiring gentle manipulation to avoid rupture and aspiration.
- Intubation was difficult due to obscured epiglottis; extubation was deferred due to airway manipulation and potential laryngomalacia.
Implications:
- This case underscores the need for meticulous airway assessment and management strategies in infants with vallecular cysts.
- Postoperative ventilation may be necessary to ensure airway stability after surgical intervention.
Abstract:
Vallecular cyst is uncommon but well-recognized cause of upper airway obstruction in newborn and infants. We hereby present anesthetic management of a case of vallecular cyst in an infant posted for excision and marsupialization. A 4-month-old female infant weighing 3.5 kg presented with inspiratory stridor progressively worsening over 2 months. Anesthesia plan was to carry out inhalational induction maintaining spontaneous respiration and keeping tracheostomy as standby option. In this case, laryngoscopy was challenging due to the size and extent of the cyst thus necessitating gentle laryngoscopy to prevent cyst rupture and pulmonary aspiration. On performing laryngoscopy, epiglottis was not visualized, which made intubation difficult. At the end of surgery, extubation was not carried out as the possibility of laryngomalacia could not be eliminated and also in view of intraoperative airway manipulation. The patient was electively ventilated postoperatively and extubated on the 2(nd) postoperative day.
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