Anaesthetic Challenges in a Paediatric Patient with Escobar Syndrome-Difficult Airway and Postoperative Pneumothorax

Area of Science:

• Anesthesiology
• Genetics
• Pediatric Surgery

Background:

• Escobar syndrome (ES) presents significant airway challenges for anesthesiologists due to craniofacial and cervical malformations.
• Associated anomalies include cleft lip/palate, micrognathia, and limited neck mobility, complicating intubation.
• Perioperative management requires careful consideration of these anatomical variations.

Purpose of the Study:

• To report a pediatric case of Escobar syndrome undergoing general anesthesia.
• To describe successful airway management using fiberoptic intubation with oxygen insufflation.
• To document rare postoperative complications, including pneumothorax with mediastinal shift.

Main Methods:

• A pediatric patient with Escobar syndrome underwent laparoscopic inguinal hernia repair and orchidopexy.
• Initial airway management attempts with video laryngoscopy and fiberoptic bronchoscopy were challenging.
• Successful intubation was achieved via nasal fiberoptic bronchoscopy with oxygen insufflation.

Main Results:

• Video laryngoscopy and standard fiberoptic bronchoscopy failed due to poor visualization and desaturation.
• Nasal fiberoptic intubation with oxygen insufflation using a 3mm endotracheal tube was successful.
• The patient experienced intraoperative hyperthermia and postoperative pneumothorax with mediastinal shift.

Conclusions:

• This case highlights the successful use of oxygen insufflation during fiberoptic intubation in a pediatric Escobar syndrome patient.
• Pneumothorax with mediastinal shift is a newly reported postoperative complication in pediatric Escobar syndrome.
• Anesthesiologists must be prepared for complex airway and perioperative challenges in Escobar syndrome.