Document Detail

Airway management in a patient with a cleft palate after pharyngoplasty: a case report.
MedLine Citation:
PMID:  12944449     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To describe a practical method of aiding nasotracheal intubation in a cleft palate patient with previous pharyngoplasty using a suction catheter under tactile guidance. Problems of airway management in these patients are also discussed. CLINICAL FEATURES: A 26-yr-old woman presented for elective Le Fort maxillary osteotomy. She had a history of cleft lip and palate and subsequent palatoplasty and pharyngeal flap. She had no symptoms of upper airway obstruction or obstructive sleep apnea. Preoperative examination revealed a hypernasal voice and patent nasal passages. Anesthesia was induced and the patient paralyzed. An attempt to pass a 6.5-mm cuffed endotracheal tube through the right nostril met with resistance. A suction catheter was introduced into the nostril, while a finger was positioned over the flap and the velopharyngeal port, until its tip rested against the flap, the catheter coiled and a small loop could be palpated past the patent velopharyngeal port. The catheter was then hooked into the oropharynx. The endotracheal tube was "railroaded" over it and advanced into the glottis. There was minimal bleeding and no desaturation during the procedure. CONCLUSION: Preoperative determination of the type of pharyngoplasty is essential to understand the anatomy of the patent velopharyngeal port. A history of pharyngeal flap infection, hyponasal voice or upper airway obstruction suggests possible port stenosis. We describe a tactile guided technique that is useful and practical. Use of a flexible suction catheter of small external diameter minimizes the potential for trauma, bleeding and creation of false passages.
Hwan-Ing Hee; Nesil Deger Conskunfirat; Shu-Yam Wong; Chit Chen
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  50     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:    2003 Aug-Sep
Date Detail:
Created Date:  2003-08-28     Completed Date:  2004-04-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  721-4     Citation Subset:  IM    
Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
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MeSH Terms
Cleft Palate / surgery*
Intubation, Intratracheal / methods*
Maxilla / surgery
Nasal Cavity
Osteotomy, Le Fort*
Pharynx / surgery

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