Syngnathia 환자의 기도관리

AIRWAY MANAGEMENT FOR SYNGNATHIA

Syngnathia(maxillomandibular fusion) is a rare congenital anomaly involving soft tissue or bony adhesions between the maxilla and mandible. Bony fusion, as in this case, is extremely rare and to the present time, no specific anesthetic management has been reported. In our case, physical examination of the 130-day infant patient(weight 5.5 ㎏) with syngnathia revealed apparent left side fusion between maxilla and mandible. The opening between upper and lower gingiva was limited to 10 ㎜ on the right side. Left choanal atresia, microstomia, low set ears and blue sclera were also detected. When patient arrived at the OR, 5 L/min oxygen was administered using nasal prong with end-tidal CO₂ monitoring cannula through mouth. Glycopyrrolate 0.1 ㎎ and ketamine 5 ㎎ were administered intravenously. A solution of 2 % lidocaine 2 ㎖ and 0.1 % phenylephrine 1 ㎖ was used to topicalize the right nostril. Subanesthetic doses(2~3 ㎎) of ketamine were used to provide sedation while maintaining spontaneous ventilation. Warm. softened I.D. 3.5 ㎜ preformed nasotracheal tube was inserted via the right nostril into the trachea with a 3.2 ㎜ O.D. fiberoptic bronchoscope. After that vecuronium and dexamethasone were given intravenously. The infant had been anesthetized uneventfully with isoflurane. Fiberoptic nasotracheal intubation under spontaneous ventilation using low doses of ketamine offers a safe and non-invasive technique compared with tracheostomy or blind nasotracheal intubation. To increase safety, oxygen should be given via nasal or oral routes and adequate monitoring, especially capnography and pulse oxymeter, should be performed.