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Acidental extubation in a patient with Pierre-Robin sequence: a case report.

Karolina Czajkowska, Liuba Germanova, Joao Bettencourt.

Abstract
The Pierre Robin sequence is characterised by a clinical triad of micrognathia, glossoptosis and airway obstruction. These patients frequently require anesthesia for diagnostic and therapeutic procedures and they may present a significant challenge to the anesthesiologist in charge. The principal difficulties when approaching those patients are related to the airway management.
We present a case of a 4 years old boy with a Pierre Robin sequence, submitted to an elective tympanoplasty. We performed an awake intubation with a fiberscope without complications. At the beginning of the surgery we verified an accidental extubation of the patient and we initiated attempts of manual ventilation, without success. Due to hypoxemia and severe bradycardia, the patient suffered a cardiac arrest. We initiated advanced life support manoeuvres and at this point the manual ventilation with a face mask was established. The patient recovered the sinus rhythm and we managed to intubate him again with a fiberscope.
In conclusion, in case of patients with Pierre Robin sequence it is essential to plan in advance the airway approach and make sure that after establishing an intubation, the tube is firmly secured, as an accidental extubation may lead to catastrophic events.

Key words: Pediatric anesthesia; Accidental extubation; Perioperative complications; Perre Robin sequence;Perioperative cardiac arrest






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The articles in Bibliomed are open access articles licensed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.