Difficult airway in a child with retropharyngeal abscess

Abstract

Retropharyngeal abscess occurs most commonly in children following acute upper respiratory tract or ear infection. We report a case of difficult airway due to retropharyngeal abscess in five years old female child, posted for incision and drainage under general anesthesia. Following inhalational induction with 6% sevoflurane in 100% oxygen, intubated with 4.5 mm ID plain Portex® endotracheal tube.

Anesthesia was maintained with 50% O₂ in N₂O and rocuronium 10 mg with traces of sevoflurane. Intraoral and lateral neck incisions were taken to drain the abscesses and extubated following satisfactory clinical recovery. However immediately after extubation the child developed severe stridor and airway obstruction leading to desaturation down to 60% of SpO₂. Three attempts for reintubation under the effect of 12.5 mg intravenous succinylcholine failed. Hence airway secured with emergency tracheostomy. Here we discuss about the anesthetic management and the immediate post operative crisis due to difficult reintubation.

Citation: Kulkarni KR, Chaurasia BR. Difficult airway in a child with retropharyngeal abscess. Anaesth Pain & Intensive Care 2014;18(3):285-88