Anesthetic management of vallecular cyst excision in an infant: An airway challenge

Abstract

Vallecular cyst is uncommon but well-recognized cause of upper airway obstruction in newborn and infants. We hereby present anesthetic management of a case of vallecular cyst in an infant posted for excision and marsupialization. A 4-month-old female infant weighing 3.5 kg presented with inspiratory stridor progressively worsening over 2 months. Anesthesia plan was to carry out inhalational induction maintaining spontaneous respiration and keeping tracheostomy as standby option. In this case, laryngoscopy was challenging due to the size and extent of the cyst thus necessitating gentle laryngoscopy to prevent cyst rupture and pulmonary aspiration. On performing laryngoscopy, epiglottis was not visualized, which made intubation difficult. At the end of surgery, extubation was not carried out as the possibility of laryngomalacia could not be eliminated and also in view of intraoperative airway manipulation. The patient was electively ventilated postoperatively and extubated on the 2nd postoperative day.

Tongue depressor as an intubation aid in a patient with vallecular cyst: A case report

“…Shifting the patient to lateral position might help to reopen the complete airway collapse at induction, especially in children [12]. The use of backward, upward, rightward pressure maneuver has been described in a 4-month-old infant [13]. Consent should also be taken for standby tracheostomy.…”

Manejo anestésico de resección de quiste de vallécula en neonato. A propósito de un caso

“…l quiste de vallécula supone una causa de obstrucción de vía aérea superior infrecuente en neonatos y niños, y cursa clínicamente con estridor y/o cianosis [1]. En la mayoría de los casos, puede asociar laringomalacia, que es la anomalía congénita de laringe más frecuente [2].…”

Giant vallecular cyst excision in infant: Should we proceed without a definite airway?

“…described a similar case, in which they intubated the child after applying cricoid pressure and extubated the child on the 2 nd postoperative day. [ 11 ] In a case report by Rivo and Matot, they detected vallecular cyst incidentally during direct laryngoscopy for intubating the patient who was posted for appendectomy. They used fiber-optic bronchoscope to intubate the patient once the patient recovered from general anesthesia.…”