LETTER TO EDITOR
Year : 2015 | Volume
: 31 | Issue : 3 | Page : 414-
Anesthetic consideration in patient with lateral nasal proboscis
Bikram Kumar Gupta1, MS Saravana Babu1, Apurva Agarwal1, Shaily Agarwal2, Vanita Mhaske3, Samir Saxena4,
1 Department of Anaesthesiology and Critical Care, G. S. V. M. Medical College, Kanpur, Uttar Pradesh, India
2 Department of Gynecology and Obstetrics, G. S. V. M. Medical College, Kanpur, Uttar Pradesh, India
3 Department of Cardiothoracic Surgery, G. S. V. M. Medical College, Kanpur, Uttar Pradesh, India
4 Department of Surgery, New Leelamani Hospital, Kanpur, Uttar Pradesh, India
Bikram Kumar Gupta
39, New Married Hostel, L. L. R. Hospital, G. S. V. M. M. C., Kanpur, Uttar Pradesh
|How to cite this article:|
Gupta BK, Saravana Babu M S, Agarwal A, Agarwal S, Mhaske V, Saxena S. Anesthetic consideration in patient with lateral nasal proboscis.J Anaesthesiol Clin Pharmacol 2015;31:414-414
|How to cite this URL:|
Gupta BK, Saravana Babu M S, Agarwal A, Agarwal S, Mhaske V, Saxena S. Anesthetic consideration in patient with lateral nasal proboscis. J Anaesthesiol Clin Pharmacol [serial online] 2015 [cited 2021 Apr 11 ];31:414-414
Available from: https://www.joacp.org/text.asp?2015/31/3/414/161702
Lateral nasal proboscis (LNP) is a rare anomaly resulting in incomplete formation of one side of the nose and other variable abnormalities in the adjoining regions of the face.  The embryologic defect that results in LNP appears to involve the nasal placode,  which is a primary organizer of the nasal area of the midface. Here, we will discuss anesthetic consideration in a patient of LNP posted for heminose reconstruction.
A 10-month-old, 8 kg female child was admitted with complaints of the trunk-like appendage arising from the left medial canthus with a clear mucoid discharge draining from an orifice at its distal end. Preanesthetic evaluation. Baseline investigations were within normal limits with a hemoglobin of 12.5 g/dl. There was no abnormal central nervous system (CNS) finding on clinical examination. Hence, contrast tomography scan of the brain was not advised. Feeding tube was inserted through the orifice of the appendage to check it's patency. She was premedicated with midazolam syrup (4 mg) orally 1 h before the procedure. After sedation, anesthesia was induced with sevofluarne in oxygen. Difficulty in mask ventilation was noted due to facial deformity. When the proboscis was uplifted towards the forehead region, proper mask ventilation became possible. Hence, atracurium was used to facilitate tracheal intubation using 4.5 noncuffed (Ring, Adair, and Elwyn) tube. Anesthesia was maintained on O 2 , nitrous oxide and sevoflurane with atracurium as a muscle relaxant. Electro cardiogram, noninvasive blood pressure, oxygen saturation, capnography, precordial stethoscope were attached. The procedure lasted 220 min. Heminose reconstruction was done successfully, and intraoperative period was uneventful. Patient shifted to high dependency unit for postoperative care. Child started taking liquids orally after 4 h.
As an anesthesiologist, we must be aware of all associated abnormalities of lateral proboscis. Lateral proboscis is mainly associated with CNS, eye and nose abnormality. A complete neurological and ophthalmological examination must be performed, and preexisting deficits should be documented. Due to facial abnormalities like absent nasal bone, facial cleft, choanal atresia, cleft lip and/or palate,  mask ventilation and intubation may be difficult to perform. Thus, we must be prepared for difficult airway management. Laryngoscopy should be gentle, and the patient should be kept in a deep plane of anesthesia during laryngoscopy. Due to associated ophthalmic lesions such as microphthalmia,  colobomas of the choroid, retina, iris, and eyelids, infraorbital encephalocele, infraorbital glioma and brain lesion like meningoencephalocele,  sphenoorbital basal encephalocele, arachnoid cyst, brainstem asymmetry, we must evaluate such patients before planning for general anesthesia. Due to the frequent associated anomalies, a multispecialty team, including staff from the otolaryngology, ophthalmology, neurosurgery, and plastic surgery departments should evaluate the patient prior to surgical repair.  The preparation of clinicians to foresee, prevent, recognize, and manage any clinical event is possible only when they know about the problem associated with LNP. This report alerts the clinicians about possibility of difficult airway management and also persuades them to be better prepared to handle such episodes.
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