case presentation on difficult airway and management

Difficult airway

1. CASE PRESENTATION

2. HISTORY A 30 year old female patient weighing 47 kg named H emangi came with chief complaints of burns over neck and chest and difficullty in swallowing; restricted mouth opening since few days. She had suffered acid burns(18% of BSA) 3 months earlier ,treated in a local hospital where she was admitted for 1 week.Repeated dressing was done under short GA. No other significant history related to RS,CVS,CNS and GI system. Her feeding and breathing were not affected. No history of tobacco ,alcohol or any drug history .

3. GENERAL PHYSICAL EXAMINATION Patient was examined adequate day light and under proper exposure. Patient is fairly built and nourished. Weight=47 kg , Height = 160 cm BMI =18.3 kg/m2 Pulse rate-82 /min and Blood pressure -107/70 mm hg.

4. AIRWAY EXAMINATION:- Mouth opening narrow with cicaterized angle of the mouth. Interincisor distance – 2 cm Mallampati Grade IV Limited restriction to flexion and extension. Thyromental distance- 6 cm. Hyomental distance – 4 cm. Sternomental distance -12 cm. Systemic examination: RS – BLAE present with no foreign sounds CVS- Heart sounds present ,with no murmur . CNS , Opthalmic and Perabdomen no abnormalities present

5. HISTORY A 28 year old ,55 kg male patient named Vikas of middle socioeconomic status,resident of Ahmedabad came with chief complaints of pain in B/L periauricular area; difficulty in chewing and restricted jaw movement. Patient is a known case of ankylosing spondylitis since 8 years. He gave a history of initial stiffness in the ankle joints and spine . He had difficulty in mouth opening since 1 year and complete inability to open his mouth since 1 month. He had undergone bilateral hip replacement surgery under spinal and epidural anaesthesia 1 ½ years ago with no postoperative complaints.

6. Family history suggests both brother and father were also affected with ankylosing spondylitis . No other significant history . No history of addiction. No history suggestive of obstructive sleep apnoea syndrome. D rug history: Capsule Indomethacin 25 mg twice daily Diet history:On liquit diet since few weeks.

7. GENERAL PHYSICAL EXAMINATION Patient was examined adequate day light and under proper exposure. Patient is fairly built and nourished . Pulse rate-88 /min and Blood pressure -120/70 mm hg AIRWAY EXAMINATION: Mouth opening : 1mm. Neck movements: moderately restricted. Minimal flexion and side to side movement and no extension of neck

8. Mallampati Grade IV. Thyromental distance :6 cm. Hyomental distance :5 cm . Calder test : Lower incisor lie posterior to the upper incisor 1 finger test : No sliding of condyle felt. He was unable to flex his back or knees and walked with help of crutches.

9. SYSTEMIC EXAMINATION: RS – BLAE present with no foreign sounds BHT of 15 seconds . CVS- Heart sounds present ,with no murmur . CNS , Opthalmic and Perabdomen no abnormalities present