Smooth Extubation Techniques in Pediatric Patients After LeFort I Osteotomy

Abstract

The anesthetic approach to patients with facial deformities, such as midface hypoplasia (MFH), is complex and requires coordinated work with the surgical team. These patients may have a difficult airway (DA), and hence special considerations must be taken from the anesthetic point of view, and several options have been described by the American Society of Anesthesiology (ASA) related to this. Multiple methods have been described for intubation and maintenance; for extubation in pediatric patients, there are no defined guidelines. Extubation can be performed under deep anesthesia or with the patient awake, taking special considerations by keeping their condition in mind; these approaches have shown varying results. Favorable outcomes have been observed in the literature and personal experiences with smooth extubation techniques in patients at a high risk of reintubation, such as those with dentofacial deformities and the pediatric population. A 15-year-old girl with a diagnosis of severe malar hypoplasia associated with a cleft lip (CL) was admitted to our hospital. She had a history of previous surgeries and had persistent functional disorders, for which surgical placement of facial distractors was scheduled. For the anesthetic approach, a balanced general anesthesia option was chosen. The use of a video laryngoscope was determined to be the proper choice for DA, with the fixation of the oral endotracheal tube (OETT) in a caudal direction, and with mechanical-ventilator settings appropriate for the patient's age. Deep extubation with smooth extubation techniques was performed successfully. No anesthetic complications were observed in this case.

Keywords: difficult airway; difficult extubation; mid-facial hipoplasia; smooth extubation.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Lucín Yagual et al.

Figures

Figure 1. Lateral cephalic X-ray

Mandibular prognathism was observed at the expense of maxillary hypoplasia (star). In soft tissues, there was drooping nasal tip (arrow); however, an unobstructed airway and preserved diameters were observed

Figure 2. Videolaryngoscopy and intubation

A: open glottis (star). B: video-assisted endotracheal tube introduction

Figure 3. Rigid external distraction with intranasal bone-borne traction Hooks for midfacial hypoplasia

Source: KLS Martin Group