title: Innovative Application of a Microlaryngeal Surgery Tube for difficult Airway Management in a Case of Down's Syndrome.
abstract: An 11-year-old male child, known case of down's syndrome with congenital oesophageal stricture was posted for oesophageal dilatation. Preoperative airway assessment revealed a high arched palate, receding mandible and Mallampati Score of 2. During surgery, after loss of consciousness which was described as loss of eyelash reflex and adequate jaw relaxation, direct laryngoscopy and endotracheal intubation was attempted with a cuffed endotracheal tube number 5.0mm ID (internal diameter). The endotracheal tube could not be negotiated smoothly, so 5.0mm ID uncuffed endotracheal tube was used which passed through easily, but on auscultation revealed a significant leak. Later, intubation via a Micro Laryngeal Surgery (MLS) cuffed tube 4.0mm ID was attempted. The MLS tube advanced smoothly and there was no associated leak on positive pressure ventilation. Thus by innovative thinking and avant-garde reasoning, a definitive airway device could be positioned with no other suitable alternative at hand.
authors.affiliation: Senior Resident, Department of Anesthesiology and Critical Care, Ram Manohar Lohia Hospital , New Delhi, India .
authors.forename: Michell
authors.initials: M
authors.lastname: Gulabani
authors.affiliation: Associate Professor, Department of Anesthesiology and Critical Care, Ram Manohar Lohia Hospital , New Delhi, India .
authors.forename: Akhilesh
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Senior Specialist, Department of Anesthesiology and Critical Care, Ram Manohar Lohia Hospital , New Delhi, India .
authors.forename: Neerja Gaur
authors.initials: NG
authors.lastname: Bannerjee
authors.affiliation: Professor and Head, Department of Anesthesiology and Critical Care, Ram Manohar Lohia Hospital , New Delhi , India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sood
authors.affiliation: Post Graduate Resident, Department of Pharmacology, M R Medical College , Karnataka, India .
authors.forename: Prashant
authors.initials: P
authors.lastname: Dass
keywords: Endotracheal intubation; Mallampati Score; Oesophageal stricture; Trisomy