Airway management of patients with craniofacial abnormalities: 10-year experience at a teaching hospital in Taiwan.

BACKGROUND: Airway management for patients with craniofacial abnormalities poses many challenges. It potentially has a high rate of morbidity and even mortality. METHODS: We reviewed our experience in administering anesthesia to patients with a diagnosis of mucopolysaccharidosis or Pierre Robin sequence in the past 10 years (July 1998 to October 2008). The anesthetic procedures, methods of airway management, and events of morbidity and mortality were evaluated. RESULTS: Thirty patients with mucopolysaccharidosis and 53 patients with Pierre Robin sequence were placed under general anesthesia. Although the anesthesiologists always encountered difficulties in managing the airway, most of the anesthetic procedures were performed safely except for 1 case that resulted in mortality. CONCLUSION: Managing the airway of patients with craniofacial abnormalities can potentially be difficult. It should be carried out by experienced anesthesiologists, with assistance from an otolaryngologist when necessary. A variety of different airway devices should be available if needed.

Rigid ventilation bronchoscopy under general anesthesia for treatment of pediatric pulmonary atelectasis caused by pneumonia: A review of 33 cases.

Pediatric pulmonary atelectasis caused by pneumonia is a common disease. If the mucus plugs or secretions occlude the bronchial trees and cannot be cleaned by coughing, suctioning, or vigorous respiratory and physical therapy, is rigid ventilation bronchoscopy (V-B) effective and safe as a therapeutic procedure in such patients? We collected 33 cases of pediatric pulmonary atelectasis that were treated by rigid V-B under general anesthesia for removal of the mucus plugs or foreign bodies. During the rigid V-B with lung lavage performed by experienced bronchoscopists, the oxygen saturation was maintained in good condition. No disastrous complications were noted. Sixty-four percent (21/33) of those with pediatric pulmonary atelectasis had significant improvement in either oxygen saturation or chest radiography within 72 hours. We conclude that when the traditional treatment in pediatric pulmonary atelectasis was ineffective, rigid V-B might be an adequate and safe procedure to remove the mucus plugs and restore pulmonary function.

Tracheal intubation condition--a comparison between one minute after rocuronium alone, one minute after rocuronium combined with atracurium and one minute after atracurium with rocuronium at one minute priming interval.

BACKGROUND: Rocuronium, a monoquaternary steroid analogue of vecuronium, is designed to provide a rapid onset of action. Experimentally, it has been shown that two non-depolarizing neuromuscular relaxants administered together can produce either a neuromuscular block of a size expected to be the sum of the individual doses (additive effect) or a larger neuromuscular block (synergistic effect). Experimental observations have suggested that during onset rocuronium acts synergistically with other nondepolarizing agents, but that at a steady state the combined action is additive. METHODS: To investigate whether rocuronium can speed up the onset of atracurium for intubation, 120 patients who consented to receive elective surgery requiring tracheal intubation were randomly assigned to 3 equally divided groups to receive one of the following three different combinations of muscle relaxants: twice ED95 of rocuronium (0.6 mg/kg group 1), an equipotent mixture of ED95 of rocuronium and atracurium (0.3 mg/kg and 0.25 mg/kg respectively, group 2), and rocuronium 0.1 mg/kg to prime atracurium 0.42 mg/kg at 1 min interval. Intubation conditions were assessed 1 minute after intravenous muscle relaxant injection, and scored as good, acceptable and poor based on four clinical evaluators: the ease of laryngoscopy (score of 1-3), the relaxation of vocal cord (1-3), the degree of coughing (1-3), and movement of extremity (1-3). Adding up together, intubation condition that scored 4-5 was considered to be good, 6-7 acceptable, and 8-12 poor. RESULTS: The conditions produced in the rocuronium and the mixture groups were similar and both were moderately better than those of the priming group. Good intubation conditions were achieved in 58% patients of the rocuronium group, 63% of the mixture group and 43% of the priming group. By Pearson Chi-square test, the comparisons did not show statistical significance between groups. CONCLUSIONS: Statistically, rocuronium alone, mixture of equipotent atracurium and rocuronium, and using rocuronium to prime atracurium all provided similar onset for satisfactory intubation.