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Chapter 48. Airway Management of a 6-Year-Old with Pierre Robin Syndrome for Bilateral Inguinal Hernia Repair

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All of the following features are associated with Pierre Robin sequence EXCEPT

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A. mandibular hypoplasia

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B. cleft secondary palate

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C. glossoptosis

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D. congenital cardiac disease

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E. normal mouth opening

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(D) Robin Syndrome (or Sequence; PRS) is a congenital disorder characterized by a triad of craniofacial anomalies: mandibular hypoplasia, cleft secondary palate, and glossoptosis. PRS is not commonly associated with major cardiac or other comorbidities. PRS children usually have normal mouth opening.

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Which of the following is TRUE regarding pediatric difficult airway management?

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A. Sedation should be never given to the uncooperative patient.

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B. Most practitioners prefer to maintain spontaneous ventilation.

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C. Inhalation induction is the only way to maintain spontaneous ventilation.

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D. “Can’t intubate, can’t oxygenate” situation does not happen in pediatric population.

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E. Emergency surgical tracheotomy can be easily performed in pediatric patients.

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(B) Most experts believe that maintenance of spontaneous ventilation must be the top priority. Despite inhalation induction being the classic approach and popular teaching technique, an IV infusion technique, such as propofol–remifentanil infusion has been successful in preserving spontaneous ventilation. Emergency surgical tracheotomy on a child is often difficult.

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Which of the following is TRUE regarding the airway devices used during pediatric difficult airway management?

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A. Flexible bronchoscopic intubation is easier via oral route than nasal route.

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B. When using video-laryngoscopes, it is recommended to insert the blade midline and do not sweep the tongue.

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C. EGDs cannot be used as conduits for flexible bronchoscopic intubation.

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D. EGDs generally do not seal well.

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E. Topicalization with local anesthetic of upper airway is often not needed as children are generally already under general anesthesia.

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(B) Pediatric flexible bronchoscopic intubation is often easier via nasal route than oral route. EGDs can generally provide good seal and can provide a very useful conduit for flexible bronchoscopic intubation. Regardless, airway topicalization is of paramount importance when providing anesthesia for any successful airway management, particularly when using bronchoscopic intubation.

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