Abstract

MORO, Eduardo Toshiyuki; ANDRADE JUNIOR, Francisco Carlos de; ANDRADE, Renato Augusto  and  OLIVEIRA JUNIOR, Sérgio Penteado de Camargo. Rhinoscope-guided nasotracheal intubation in a one-year old child with Osteogenesis imperfecta: case report. Rev. Bras. Anestesiol. [online]. 2009, vol.59, n.5, pp. 610-613. ISSN 0034-7094.  http://dx.doi.org/10.1590/S0034-70942009000500010.

BACKGROUND AND OBJECTIVES: Osteogenesis imperfecta (OI) is a rare, autosomal dominant disease. Anesthesia for patients with OI has several challenges; among them, management of the airways and the choice of anesthetic technique should be mentioned. The objective of this report was to describe the case of a child with this disorder associated with hydrocephalus who underwent total intravenous anesthesia and rhinoscope-guided nasotracheal intubation for a ventriculoperitoneal shunt. CASE REPORT: This is a 15-month old male with OI (type III) and hydrocephalus who underwent placement of a ventriculoperitoneal shunt. After the oral administration of midazolam (1 mg.kg^-1) 30 minutes before the procedure, the child was monitored and, afterwards, a 24G catheter was used for venipuncture. After oxygenation, anesthesia was induced with remifentanil, propofol, and cisatracurium. A 4.5-mm ETT with balloon was used for the rhinoscopeguided (Olimpus^® ENF P3) nasotracheal intubation without intercurrences. Anesthesia was maintained with the infusion of remifentanil and propofol. The surgery lasted 120 minutes, without intercurrences. CONCLUSIONS: The present report described an alternative for the access of the upper airways in children undergoing general anesthesia and who, for some reason, cannot be ventilated with a laryngeal mask. Since the rhinolaryngoscope has a reduced diameter, it allows the insertion of ETTs that could not be used with conventional fiberscopes.

Keywords : ANESTHESIA, General [intravenous]; DISEASES, Genetic [Osteogenesis imperfecta]; INTUBATION, Tracheal [nasotracheal].