Bifid Epiglottis: What Perioperative Physician Should Know about It?
نویسندگان
چکیده
479 The Editor, A 7‐year‐old male child visited preoperative clinic for preanesthetic evaluation. He was posted for urological procedure. On history, he was first child of normal parents. On examination, he was 35 kg in weight and having course facial features. At birth, he was diagnosed to have high anorectal malformations (ARMs), penoscrotal hypospadias, polydactyly, bilateral congenital talipes equinovarus, and left renal agenesis. Child’s mental progress was also not aged appropriate. He has undergone surgery for high ARM at birth uneventfully. His clinical examination and laboratory investigations were within normal limits. His chest radiograph, 12 lead electrocardiography and two‐dimensional echocardiography were also normal. Hormonal assay showed a testosterone level of 1.6 nmol/L (normal 9–35 nmol/L for males). No chromosomal abnormality was diagnosed on karyotyping. Airway examination revealed a mouth opening of 2 cm with large tongue. Previous anesthesia records were not available. Routine anesthesia induction was done with sevoflurane in oxygen, 70 μ fentanyl, and 20 mg atracurium. On direct laryngoscopy for tracheal tube advancement, a bifid epiglottis with complete slit up to base of epiglottis [Figure 1] was seen. Backward, upward, and rightward pressure was applied by assistant in lieu of high placed glottis and a size 5 ID tracheal tube was advanced into trachea with slight difficulty. Anesthesia was maintained on sevoflurane (inhaled concentration 1.5%–2%) in oxygen and air (40:60). After 4 h at the end of surgery, moderate inspiratory stridor was present after tracheal extubation. He was kept in lateral position in postanesthesia care unit and supplemental oxygen was given by venturi mask (FiO2 0.5). His recovery was uneventful and shifted to ward on evening.
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