Abstract
Difficulty in maintaining the airway including tracheal intubation is often encountered in patients with Treacher Collins syndrome (TCS) due to their characteristic facial deformity. We report a case of difficult intubation under general anesthesia in a child with Treacher Collins syndrome with unanticipated difficult ventilation by anesthetic mask. A 7-year-old girl with TCS underwent removal of the preauricular sinus. Nasal continuous positive airway pressure was administered to her while she slept, as she was expected to be difficult to ventilate by anesthetic mask and tracheal intubation. However, we assumed that assisted ventilation by anesthetic mask would be possible. Therefore, at first, a laryngeal mask airway-ProSeal® (PLMA) was placed under assisted ventilation. Fiberoptic scope-guided tracheal intubation was then performed through the PLMA. However, when rapid anesthetic induction with sevoflurane was performed, we had difficulty with the assisted ventilation but managed to continue to ventilate her with assistance without hypoxia. Although we successfully managed her using this airway strategy, we believe that the airway management in this case needs to be discussed.
