[Rhinoscope-guided nasotracheal intubation in a one-year old child with Osteogenesis imperfecta: case report].
OBJECTIVE
Osteogenesis imperfecta (OI) is a rare, autosomal dominant disease. Anesthesia for patients with OI has several challenges; among them, management of the airways and the choice of anesthetic technique should be mentioned. The objective of this report was to describe the case of a child with this disorder associated with hydrocephalus who underwent total intravenous anesthesia and rhinoscope-guided nasotracheal intubation for a ventriculoperitoneal shunt.


METHODS
This is a 15-month old male with OI (type III) and hydrocephalus who underwent placement of a ventriculoperitoneal shunt. After the oral administration of midazolam (1 mg.kg-1) 30 minutes before the procedure, the child was monitored and, afterwards, a 24G catheter was used for venipuncture. After oxygenation, anesthesia was induced with remifentanil, propofol, and cisatracurium. A 4.5-mm ETT with balloon was used for the rhinoscopeguided (Olimpus) ENF P3) nasotracheal intubation without intercurrences. Anesthesia was maintained with the infusion of remifentanil and propofol. The surgery lasted 120 minutes, without intercurrences.


CONCLUSIONS
The present report described an alternative for the access of the upper airways in children undergoing general anesthesia and who, for some reason, cannot be ventilated with a laryngeal mask. Since the rhinolaryngoscope has a reduced diameter, it allows the insertion of ETTs that could not be used with conventional fiberscopes.
CET, SBP, Faculdade de Medicina, PUC, SP. edumoro@terra.com.br
Eduardo Toshiyuki
ET
Moro
Francisco Carlos de
FC
Andrade Júnior
Renato Augusto
RA
Andrade
Sérgio Penteado de Camargo
SP
Oliveira Júnior
D000768:Anesthesia, General; D004724:Endoscopy; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D009666:Nose; D010013:Osteogenesis Imperfecta