A new technique for laryngeal mask airway insertion in a newborn with pierre-robin syndrome: a case report

Abstract

Babies with Pierre Robin syndrome have serious life-threatening risks because of acute respiratory distress and difficult airway management. It is difficult to perform endotracheal intubation in these babies for general anesthesia. We present successful insertion of laryngeal mask airway in a neonate with typical clinical features of Pierre-Robin syndrome using a size 1 laryngeal mask airway for a ventriculoperitoneal shunt operation. The patient had micrognathia, glossoptosis with cleft palate, and partial trismus. His mouth opening was restricted to 0.6 cm. Anesthesia was deepened with sevoflurane, maintaining spontaneous ventilation, but laryngoscopy was impossible because of the limited mouth opening. After unsuccessful attempts to insert an LMA by standard and rotational techniques, it was inserted using a novel modified rotational LMA insertion technique, which we have termed the 'squeezing technique'.

Keywords: Difficult endotracheal intubation; Laringeal maske; Laryngeal mask airway; Pierre-Robin sendromu; Pierre-Robin syndrome; Zor endotrekeal entübasyon.

Fig. 1

Patient’s mouth opening (large picture) and lateral appearance (small picture) of patient with Pierre Robin syndrome

Fig. 2

The squeezing technique of the cuff-shaft junction by the first and second fingers. Arrows show the pressure directions. A: Photographic view. B: Schematic view.