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[Perioperative Management of a Child with Vocal Adhesion Leading to Unexpected Difficult Airway]

Takashi Hitosugi, Masanori Tsukamoto, Shigeki Fujiwara

    Masui. the Japanese Journal of Anesthesiology
    |August 4, 2016
    PubMed

    Insights

    Severe stridor in infants may indicate vocal cord adhesion, even with normal laryngofiberoptic exams. This condition can complicate anesthesia, requiring specialized intubation techniques.

    Area of Science:

    • Pediatric Anesthesiology
    • Otolaryngology
    • Neonatal Intensive Care

    Background:

    • A 4-month-old infant presented for bilateral lip plasty.
    • The infant had a history of prolonged intubation due to neonatal pneumonia.

    Observation:

    • Post-extubation, the infant developed hoarseness and severe stridor.
    • Multiple laryngofiberoptic examinations failed to identify airway abnormalities.
    • Laryngoscopic intubation was impossible due to suspected vocal cord adhesion.

    Findings:

    • Vocal cord adhesion was diagnosed intraoperatively, necessitating fiberscope-guided tracheal intubation.
    • The infant required intensive care post-surgery and a subsequent tracheotomy.

    Implications:

    • Infantile stridor warrants careful evaluation for airway narrowing, including vocal cord adhesion, prior to general anesthesia.
    • Advanced airway management techniques may be crucial in cases with subtle or undiagnosed laryngeal pathology.
    • Early recognition and intervention are vital for managing pediatric airway emergencies during anesthesia.

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