West syndrome is a rare and severe form of epilepsy that occurs in early infancy. It is characterized by a triad consisting of infantile spasms, mental retardation, and interictal electroencephalogram pattern termed hypsarrhythmia. A thorough preoperative assessment forms a very important part in the anesthetic management of such patients considering the possibility of difficult intubation because of the coexisting anatomical malformations, establishment of peripheral intravascular access, and careful positioning due to contractures, seizures, and the adverse effects of drugs taken for it. We present anesthesia management of a case of West syndrome with subtrochanteric fracture femur posted for intramedullary nailing. Keywords: Difficult intubation, infantile spasms, mental retardation, West syndrome.
Patients coming for atlantoaxial dislocation surgery represent a unique subset of difficult intubation. In addition to having restricted neck movements, excessive movements at the neck joint during intubation must be avoided to avoid further compression. In view of the anticipated difficult intubation, adjuncts or introducers may be required to aid intubation, the most commonly used being bougies. Complications are known to occur with the use of bougies but fortunately the incidences are far and few. The most dreaded of these is pneumothorax, secondary to trauma by the bougie. The use of an adult bougie for pediatric intubations could possibly increase the risk of the same. Here, we report two incidences of pneumothorax after bougie-guided intubation.
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