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Airway emergency during general anesthesia in a child with plastic bronchitis following Fontan surgery: a case report
Hirofumi Nakamoto1, Satoru Kayama2, Mae Harada2
1Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. hirofumi_nakamoto_ryukyu@yahoo.co.jp.
Insights
Plastic bronchitis, a Fontan surgery complication, caused a critical airway emergency during anesthesia in a child. Prompt intervention and mucus plug expectoration stabilized the patient, highlighting the need for preparedness.
Area of Science:
- Anesthesiology
- Pediatric Cardiology
- Pulmonology
Background:
- Plastic bronchitis (PB) is a serious complication following Fontan surgery.
- PB involves mucus plug formation in the tracheobronchial tree, leading to life-threatening airway obstruction.
- This case highlights a critical airway emergency during general anesthesia in a pediatric patient with PB.
Purpose of the Study:
- To report a case of critical airway emergency during general anesthesia in a child with plastic bronchitis.
- To emphasize the challenges in managing airway obstruction in PB patients.
- To inform anesthetic planning for patients with plastic bronchitis.
Main Methods:
- A 5-year-old boy with a history of Fontan surgery and recurrent respiratory failure due to PB underwent general anesthesia for intrapulmonary lymphatic embolization.
- Mechanical ventilation became severely impaired post-intubation due to airway obstruction.
- Administration of sugammadex, naloxone, and flumazenil facilitated expectoration of a large mucus plug, resolving the obstruction.
Main Results:
- Difficult mechanical ventilation was encountered immediately after tracheal intubation.
- Significant airway obstruction due to a large mucus plug was identified.
- Successful expectoration of the mucus plug led to stabilization of respiratory condition.
Conclusions:
- General anesthesia in patients with plastic bronchitis poses significant risks of airway obstruction.
- Anesthetic management should include preparedness for immediate intervention, such as extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB).
- Careful planning and standby support are crucial for safe anesthesia in these high-risk patients.
Background:
Plastic bronchitis (PB) is a complication of Fontan surgery, results in the formation of mucus plug in the tracheobronchial tree, causing potentially fatal airway obstruction. We report critical airway emergency during general anesthesia in a child with plastic bronchitis.
Case Presentation:
A 5-year-old boy was scheduled for intrapulmonary lymphatic embolization through percutaneous catheterization under general anesthesia. He underwent Fontan surgery at the age of 2 and frequently developed respiratory failure due to plastic bronchitis. After induction of general anesthesia and tracheal intubation, mechanical ventilation became difficult even with an inspiratory pressure ≥ 50 mmHg due to airway obstruction. He expectorated a large mucus plug through the tracheal tube after administration of sugammadex, naloxone, and flumazenil, and respiratory condition was stabilized thereafter.
Conclusion:
General anesthesia for a patient with plastic bronchitis should be planned with extracorporeal membrane oxygenation or cardiopulmonary bypass stand by.
