Pierre Robin Syndrome
Considerations
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Pediatric patient considerations
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Difficult airway due to micrognathia, mandibular hypoplasia, glossoptosis:
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Improves with age
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Difficult bag mask ventilation & intubation
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Obstructive sleep apnea:
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Pulmonary hypertension, cor pulmonale
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Negative pressure pulmonary edema
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May need to be nursed prone
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GERD, aspiration pneumonias
Airway Management
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If intubation required:
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May be impossible: maintain spontaneous ventilation
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Inhalational induction vs. titrated TIVA induction followed by asleep fibreoptic intubation
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Strongly consider having an ENT surgeon equipped with a rigid bronchoscope on standby
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Airway obstruction:
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Oral & nasal airways, pull tongue forward, consider suturing to lip, prone position
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LMA placement followed by fibreoptic intubation through the LMA
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Nasal fiberoptic bronchoscopy
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Lightwand
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If intubation not required (e.g. myringotomy & tubes):
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IV/IH induction followed by LMA placement
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Attempt to maintain SV
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If airway obstruction occurs, paraglossal laryngoscopy may relieve obstruction & allow oxygenation to resume
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Maintain with TIVA
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