Accidental extubation in a patient with Pierre-Robin syndrome: a case report

The Pierre Robin syndrome (PRS) is characterized by a clinical triad of micrognathia, glossoptosis and airway obstruction. These patients frequently require anesthesia for diagnostic and therapeutic procedures and may present a significant challenge to the anesthesiologist in charge. The principal difficulties when approaching these patients are related to the airway management. We present a case of a 4 years old boy with a PRS, scheduled to undergo 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, but without success. Due to hypoxemia and severe bradycardia, the patient suffered a cardiac arrest. We initiated advanced life support maneuvers 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 PRS it is essential to plan in advance the airway management approach and make sure that after establishing an intubation, the tube is firmly secured, as an accidental extubation might lead to catastrophic events.