title: A case of difficult airway due to lingual tonsillar hypertrophy in a patient with Down's syndrome.
abstract: In this report, we describe airway management of symptomatic lingual tonsillar hypertrophy in a pediatric patient with Down's syndrome. Besides obstructive sleep apnea, the history included a small atrial septal defect with mild aortic regurgitation and Moyamoya disease. Anesthesia was induced with IV administration of 1 mg/kg of propofol, followed by inhalation of sevoflurane in 100% oxygen. Muscle relaxants were not used on induction. Rigid laryngoscopy could not visualize the epiglottis because of hypertrophied tonsillar tissue, and mask ventilation became difficult when spontaneous breathing stopped. We avoided using a laryngeal mask airway because of a slight bleeding tendency presumably caused by preoperative antiplatelet therapy. Fiberoptic bronchoscopy through the nasal cavity in combination with jet ventilation successfully identified the glottis and allowed nasotracheal intubation to be accomplished. After lingual tonsillectomy, the patient was extubated on the seventh postoperative day, after supraglottic edema had resolved. Fiberoptic nasotracheal intubation under inhaled anesthesia may therefore be preferable in pediatric or uncooperative patients with symptomatic lingual tonsillar hypertrophy.
authors.affiliation: Department of Anaesthesiology & Critical Care Medicine, Tokyo Medical & Dental University School of Medicine, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakazawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ikeda
authors.forename: Seiji
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Koshi
authors.initials: K
authors.lastname: Makita
mesh_terms: D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D001999:Bronchoscopy; D002648:Child; D004314:Down Syndrome / Q000150:complications / Q000473:pathology*; D004487:Edema / Q000628:therapy; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D007828:Laryngoscopy; D014066:Palatine Tonsil / Q000473:pathology*; D011183:Postoperative Complications / Q000628:therapy; D014059:Tongue / Q000473:pathology*; D014068:Tonsillectomy / Q000379:methods*