piperidines and Cherubism

For a predicted difficult airway, oral intubation techniques are well established in pediatric anesthesia, but nasotracheal intubation remains a problem. There are many reports concerning this, but the risk of bleeding, added to the lack of cooperation make this procedure difficult and hazardous. We describe a modification of the nasal intubation technique in two stages. First an oral intubation and then exchanging the oral for a nasal tube, in the case of a 13-year-old boy affected by an advanced stage of cherubism. Oral intubation using a laryngeal mask technique has already been reported, but problems appear during the exchange procedure and even more when direct laryngoscopy is impossible. Fiberscopic control of the exchange, and the introduction of a Cook Exchange Catheter into the trachea through the oral tube before withdrawal, permits oxygenation of the patient and acts as a guide for oral tube reintroduction if required.

Topics: Adjuvants, Anesthesia; Adolescent; Airway Obstruction; Anesthetics, Intravenous; Atropine; Cherubism; Fiber Optic Technology; Humans; Intubation; Jaw Abnormalities; Laryngeal Masks; Magnetic Resonance Imaging; Male; Mouth; Nasal Cavity; Orthognathic Surgical Procedures; Piperidines; Propofol; Remifentanil; Tomography, X-Ray Computed