Hien Van Vo Quynh Van Nguyen Thu Dang Nguyen Nam Hoai Tran

Keywords: Surgical Release, Post-Burn Scar Contracture, Local Anesthesia, Intravenous Anesthesia, Difficult Endotracheal Intubation, Airway Management, Airway

Abstract

Administering anesthesia to pediatric patients with maxillofacial post-burn contractures poses significant challenges, particularly due to anticipated difficulties in airway management. We report two cases involving children with severe perioral adhesive scar contractures that resulted in markedly restricted mouth opening. These cases illustrate the complexity of anesthetic planning in such scenarios and emphasize the need for individualized strategies to ensure safety and effectiveness. In both cases, flexible bronchoscopy-guided intubation was not feasible due to anatomical limitations. Instead, a two-stage anesthetic approach was employed: initial intravenous anesthesia combined with local infiltration for scar release, followed by the placement of a supraglottic airway (ProSeal™ laryngeal mask airway) to establish adequate ventilation. Both patients were managed successfully, with stable intraoperative hemodynamics and uneventful postoperative recovery.

Conclusion: Comprehensive preoperative airway evaluation is critical in pediatric patients with facial and cervical burn contractures. A staged anesthetic technique involving scar release under intravenous and local anesthesia can facilitate effective airway management and improve perioperative outcomes.

Abbreviations: LMA: laryngeal mask airway; ETI: endotracheal intubation; NIBP: non-invasive blood pressure; EtCO2: end-tidal carbon dioxide

Keywords: Airway; Airway Management; Difficult Endotracheal Intubation; Intravenous Anesthesia; Local Anesthesia; Post-Burn Scar Contracture; Surgical Release

Citation: Vo HV, Nguyen QV, Nguyen TD, Nam NH. Airway management in pediatric patients with severe post-burn oral contractures: A report of two cases. Anaesth. pain intensive care 2025;29(4):425-229. DOI: 10.35975/apic.v29i4.2832

Received: March 25, 2025; Revised: May 6, May 12, 2024; Accepted: May 20, 2025