TMJ Ankylosis – Airway Management, Anaesthesiologist Dilemma: Awake Or Anesthetized?
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 12
Abstract
Introduction: Temporo-mandibular (T-M) joint ankylosis presents a challenge to the anaesthesiologist as airway management may be quite tricky and difficult. Intubation by awake fibre-optic laryngoscopy (FOL), though favoured by many, presents difficulties of its own as the patient may be coughing, bucking &/or struggling throughout the procedure besides eliciting hemodynamic responses which may be undesirable in some patients. An anesthetized patient, in such a situation, may be quite easy to handle. Study Aims: To determine the ease of intubation in cases of T-M joint ankylosis in anesthetized patients. Patients & Methods: 10 ASA I & II patients, aged between 10 & 60 years, undergoing maxillo-facial surgery for TMJ Ankylosis. Preoperative evaluation did not reveal any airway abnormality other than the process for which the patients were being operated. Premedication with Midazolam (0.03 mg/kg) & Glycopyrrolate (0.004 mg/kg) was used in all the cases. Patients were anesthetized with Propofol (1.5 - 2.5 mg/kg) & after confirmation of ability to ventilate the patient, each patient received Succinylcholine (0.6 mg/kg). Fibreoptic (FOL) laryngoscopy was then tried. All the patients were monitored for hemodynamic variables, SpO2 & ECG abnormalities. Results: FOL assisted intubation was successful in all the patients with a mean time of 63 seconds. Hemodynamic variables before & after intubation were comparable. No patient showed desaturation (SpO2 < 93 %) or any ECG abnormality. Conclusions: A careful preoperative evaluation & assessment can help in successful airway management under anaesthesia with FOL.
Authors and Affiliations
Dr. Rakesh Sadhu, Dr. Sudha Khurana, Dr. Leena Jad, Dr. Ritika Jindal, Dr. Sachreet Kaur, Dr. Geetashu Duggal
Keywords
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- EP ID EP250601
- DOI 10.9790/0853-1612035356
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