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Infantile Cystic Hygroma: An Unusual Perioperative Course
Suman Saini1, Madhu Dayal1, Amita Gupta1
1Department of Anaesthesia, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India.
Insights
Managing infant airway with a giant cervical lump is challenging. A Proseal laryngeal mask airway (LMA) facilitated ventilation in an infant with a huge cystic hygroma, despite initial difficulties.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Giant cervical lumps, such as cystic hygromas, pose significant airway management challenges in infants.
- Recurrent respiratory infections and distress are common complications requiring intervention.
Observation:
- A one-year-old infant with a huge cystic hygroma experienced respiratory compromise.
- Sclerotherapy was ineffective, necessitating surgical excision.
- Bag-mask ventilation was unsuccessful; inhalational induction followed by Proseal laryngeal mask airway (LMA) insertion was employed.
Findings:
- The Proseal LMA provided a crucial conduit for airway maintenance during the procedure.
- Postoperative management included tracheostomy and a prolonged intensive care unit (ICU) stay.
Implications:
- This case highlights the critical need for specialized anesthetic preparation and airway management strategies for infants with large cervical masses.
- Early consideration of advanced airway devices and potential need for tracheostomy is essential for successful outcomes.
Abstract:
Airway management of an infant with a giant cervical lump may be a difficult task. The anesthesiologist must be prepared to face associated challenges during securing the airway in such patients. We report our experience with One year old infant who presented with huge cystic hygroma in the cervical region leading to recurrent episodes of respiratory tract infection and distress. Surgical removal was needed as sclerotherapy proved ineffective in reducing its size. Proseal laryngeal mask airway was used as a conduit after inhalational induction since airway could not be maintained with bag and mask. The child was tracheostomized postoperatively and also had a prolonged Intensive Care Unit stay. Difficulties encountered in intubation and postoperative management of this child are discussed in this report.
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