J Dent Anesth Pain Med.  2020 Feb;20(1):49-53. 10.17245/jdapm.2020.20.1.49.

Difficult intubation caused by an immature upper airway in a patient with cri-du-chat syndrome: a case report

• So E
• Kim S

• KMID: 2471174
• DOI: http://doi.org/10.17245/jdapm.2020.20.1.49

Abstract

Cri-du-chat syndrome (CdCS) is caused by the deletion of the short arm of chromosome 5. Most patients with CdCS develop intellectual disabilities. Therefore, they have poor oral hygiene and a high caries index. However, treating such patients is not an easy task, because of the difficulty in communication. General anesthesia may be a useful option in adult patients with CdCS and intellectual disability. General anesthesia should be administered very carefully, owing to the presence of comorbid diseases, which may need airway management. Infants with CdCS need general anesthesia if they have a concomitant cardiac anomaly. Intubation is reportedly difficult for such patients was, owing to the structural and functional abnormalities in the larynx and vocal cords. The purpose of this study was to report a case of difficult intubation while inducing general anesthesia in a patient with CdCS during dental treatment, due to a narrow larynx and trachea.

Keyword

Airway Management; Anesthesia; Congenital Abnormalities; Cri-du-Chat Syndrome; Outpatients

MeSH Terms

Adult
Airway Management
Anesthesia
Anesthesia, General
Arm
Centers for Disease Control and Prevention (U.S.)
Chromosomes, Human, Pair 5
Congenital Abnormalities
Cri-du-Chat Syndrome*
Humans
Infant
Intellectual Disability
Intubation*
Larynx
Oral Hygiene
Outpatients
Trachea
Vocal Cords

Figure

• 

  Fig. 1 Laryngoscopic field of view (in the stable condition) after successful intubation using a size 3 Macintosh curved blade. The Cormack-Lehane Grade was 4 before intubation, but intubation could not be delayed to take a photograph.

• 

  Fig. 2 A: Field of view using video laryngoscopy. A small epiglottis and vocal cord are visible. Vocal cord is fully relaxed. B: The vocal cord is completely covered by Yankauer's suction with an outer diameter of 9.4 mm. C: Intubation with endotracheal tube with an outer diameter of 8.0 mm and an inner diameter of 5.5 mm with a balloon.

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