Anaesthetic management for open supra–pubic catheterisation in a child with laryngeal web : A Case report

Dr. Tulsi K Patel; Dr. Harshali Patil; Dr. Vithal K Dhulkhed; Dr. Avinash Dubey; Dr. Nasrat Imam

Volume : VIII, Issue : IV, April - 2019

Anaesthetic management for open supra–pubic catheterisation in a child with laryngeal web : A Case report

Dr. Tulsi K Patel, Dr. Harshali Patil, Dr. Vithal K Dhulkhed, Dr. Avinash Dubey, Dr. Nasrat Imam

Abstract :

INTRODUCTION: Endotracheal intubation in a child with laryngeal web is a difficult challenge to the anaesthesiologist. We report the use of spinal anesthesia in a child with laryngeal web to avoid the difficult airway–related complications. CASE REPORT: A 5 years old child weighing 9.8 kg came with history of posterior urethral valve and posted for open suprapubic catheteriasation. Patient had stridor since 3 months. Patient had undergone multiple surgeries previously under general anaesthesia. Microlaryngoscopy was suggestive of supraglottic stenosis and anterior laryngeal web with vocal cord oedema. X–ray chest was suggestive of right sided tracheal deviation. On the day of surgery, patient was premedicated with intramuscular (ketamine/midazolam/glycopyrolate); (50mg/1mg/0.04mg). Spinal anaesthesia was administered with hyperbaric bupivacaine 0.5% 0.8 CC at L4–L5 interverteal space. Adequate spontaneous mask ventilation was ensured by providing O2 and air through Jackson Rees circuit . The child was monitored in the postanesthesia care unit for four hours and later sent to the ward. He was discharged from the hospital uneventfully. CONCLUSION: Spinal anesthesia is a safer option in a child with a difficult airway to reduce the complications related to difficult endotracheal intubation and ventilation. Difficult airway trolley and smaller size ETTs should always be kept ready at hand in case of any complication.